HomeMy WebLinkAboutCancel permit 04!11!2016 15:09 1
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Planning&Development Services RECEIVED APR
Building&Code Regulations Division
# 2300 Virginia Ave.
* Fort Pierce,FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF ONTRACTOR
Or Subcontractor o ancellation of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 4111/16 Permit Number: 1603-0437
Site Address' 2807 Carol Place.Fort Pierce,FI. 34947
io'iliae-c a &L, AiC""' State License EC 13006MB SLC License
Original General Contracto r Subcontractor)
State License, SLC License
New General Contractor(or Subcb tractor.) OM6015D&C ECr � O T '
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Reason for Change H°meewnerdodeednot tohmPwTw4gwtedwortaonetormtepatf*LMn¢.namaPa,mararwcntroanaane.
The undersigned does hereby agree to indemnify and hold harmless St.Lucie County,its officers,
agents,and employees from all costs,fees, or damages arising from any and all claims of action for
any reason.,which may ar' s a result of this change of contractorlsubcontractor or cancellation of
permit. ca be cancelled if work has been performed.
SIGN OF (or owner/bui r)) •SIGNATURE OF NEW GENERAL CONTRACTOR
PRINT NAME PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St Lucie County
The following instrument was acknowledged before me this The following instrument was aclo►owledged before me this
112!day of April 20 is by John A Pankraz day of 20__,by
-
X who is personally know to me who is personally know to me
or who has producedfas To or who has produced as ID.
Signatu o�ry Date Signature of Notary Date
*Only signature required for change of subcontractor
Revised 07/21/19 —
•s�Mor611. NANCY LEE LANGFORD
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°- MY COMMISSION#EE830242
p EXPIRES Octobar 12,2016
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