HomeMy WebLinkAboutPermit Cancellation0001PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
23OO VIRGINIA AVE
FORT PTERCE, FL 34982
(772\ 462-Lss3 FAX 462-1578
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 mnst 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 chanses are to be comoleted bv the seneral contractor
The new subcontractol must fill out a Sr"Lbcontractor Agreement Form, There is a $50.00 fee for the Change of Sub-
CELLATION OF PERMIT - The cancellation of a
Cancellation of permit is to be signed and notarized by both the
cancellation of the permit.
Date: t- q-11
pennit is acceptable only if no work has been done.
owner and qualifier of record. There is no fee for
Site Address:
Original GC, s or owner/builder
State License SLC License
New GC, subcontractor
Reason for Candellation
The undersigned does hereby agree to indemnifl and hold harmless St Lucie County, its officers, agents and employees fi'om 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
conJractor/subcontracpr or c ellation of permit. A permit cannot be cancelled if,work has been performed.
PR]NT NAME
State of Florida, County of St Lucie Cor"rnty
PRINT NAM E
State of Florida, County of St Lucie County
ing
of
whqis personally known to . ,---;
l'ro'11
Revised 04/I5/16
DAI{E!.I-E frN WESEMAN
MY Cotulil4lSS|ON # FF961459
EXFIRES February 16, 2020
{,107,:109.0153 FloridaNdaryssrylcocoo
Permit Number:
State License License
SICNA'IURE CENERALSIGNATURE OF OWNER (or owner/builder)(or new GC, as applicable)
ure of Notary
D,ANE!.LE &I UVESEMAN
MY COfuIMISSION # FFSS1459
EXPIRES February 16, 2a20
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