HomeMy WebLinkAboutCANCELLATION OF PERMITSCANNED
BY
PLANNING & DEVELOPMENT SERVICES St. Lucie ie
BUILDING & ZONING DIVISION County
2300 VII2GINIA AVE RECEIVED
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 NOV 0 6 2019
ST' Lucie=mitting
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: to, ti10y z v) R
Permit Number:
SiteAddress:C of L'.oc.onL�,_A- PA-->--, Ko/'4-IN. PSLr '(`L.
0 Wh eY— State License SLC License
Original GC, subcontractor or ownerlbuilder
License SLC License
New GC, subcontractor
Reason for Cancellation
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/subcontra{ctorr or cancellationofpermit. A permit cannot be cancelled if work has been performed.
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SIGNATURE OF OWN (or ownerfbuilder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
� day of 0;0 20 " by `0 h -A
ln4 C O c T_ ck\4 who is personally known to me
or who has produced Tt' L as D.
DHINNAMARIE GIVENS
My COMMISSION N GG 022023
EXPIRES: December 16,2020
Bonded Thru Notary Public Undenuitsm
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who is personally known to
me or who has produced as In.
Signature of Notary Date