HomeMy WebLinkAboutCANCELLATION OF PERMITBUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 OCT 18 2019
(772) 462-1553 FAX 462-1578 permitting Department
St. Lucie County, FL
BY
PLEASE SELECT ONE OF THE FOLLOWING: St. Lucie County
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 '($7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR - Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
Cr.
7CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: if )o - 1u Zo
Permit Number: I g L 1' Oil o
Site Address: * S7o 3 o l ey ill- a UL &_ 2C Lc L -<*i?
Ctt) / wtr Ira//' State License SLC License
Original GC1 subcontractor or owner/builder
License SLC License
New GC, subcontractor
Reason for
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St Lucie County
The following instrument was acknowledged
, before m is
day of�, 201 % by f U )
1 T who is personally known to me
o ro has produc r -
Signature of qoky Date
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
State of Florida, County of St Lucie County
e')'following' en was aclnrokvledged befA2 t Jmtitis
dayof 1�l 20
wh is Dersonaliv known to
me t i o has roduo
Signature of Notary Date
Revised 09/15/16 "N '.•""�•; I 7B11,RE ;: MYCOM0817�. '' EXP3Fi;'•' Bonded Thrn"ters '.
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"0 - EXPIRES: March 6, 2023
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