HomeMy WebLinkAboutPermit Cancel RequestPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
23OO VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-ts78
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,
andthenewcontractorofrecordforthe 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 subrnitted 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 fiIl 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:Permit Number:
Site Address:
Original GC, subcontractor or
State License SLC License
New GC' subcontracto'
cc't't'uc e-tr + 6l \-ol+, -Y-\sn Ccfnll\io-ncl- dl ct.l.lt-o
(rvv-t-0- \,.{d . tn 0r^) il0 vr"Lit !t\k
rnor
Reason for Cancellation
The undersigned does hereby agree to indemni! 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 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
Slate ofFlorida, County ofSt Lucie County
The following instrument was aclcnowledged before me this
duy oL_,20_, by_
who rs personally known to ure
or who has produced as ID
Signature of Notary
Revlsed 04/15/L6
SIGNATURE GENERAL (or new GC, as applicabJe)
State ofFlorida, County ofSt Lucie County
MY CoMMISSION # FFS61459
EXPIRES Fabruary 16' 2020