HomeMy WebLinkAboutCANCELLATION OF PERMIT) %
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE SCANNED
FORT PIERCE, FL 34982 BY
(772) 462-1553 FAX 462-1578 St. Lucie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
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 -
Contractor.
CANCELLATION 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: 0/3/2019 PermitNumber: `r
r: 1,8/0�3-0448
SiteAddress: ' 1- Q>—( �i�Q_Q.(`X1 o6---e CA ' f 22= � )
EDDIE GRUNDEL TOMS MOBILE HOMES State License IH1118487 SLC License
Original GC, subcontractor or owner/builder
RONALD SLAIN ANCHOR DOWN MOBILE HOMES State License IH SLC License
New GC, subcontractor
Reason for Cancellation Due to heavy work load
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its offtcers4 agents and employees from all
costs, fe s or damages arising from any and all claims of action for reason, which may arise as a result of this change of
con �r/subcontr or or cancellation of permit. A permit ranee a cancelled ' ark has been performed.
ONAIUREU U (or oener/builder) SIGNATURE ' N CO--NTRpACTU era vG(:,as applicablo)
PRINT NAMEYL-
State of Florida, County of SL Lucia County Slate of Florida, County of SL Louie County
Tho foaoain ant ems aolaowi me this The followin t was uoSvo vlodgcd before me this
day or ^ .20lq .by 49}J1Q, day O,,by
�A •1��iw is peesuaaay knower me (.ile. _%%he is versomlly known to
Revised 04/15/16 ERE
State of Florida
nn Slaughter
ion GG 123756
4/2021
NOYary Pubtie State of Florida
Kimberly Ann Slaughter
MY COmmission G0123756
�!y A Expinu o7R412021