Fillable CONTRACTOR REQUEST TO CANCEL A PERMIT (Broward County)

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CONTRACTOR REQUEST TO CANCEL A PERMIT (Broward County)

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Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION
1 N. University Drive, Box #302 • Plantation, Florida 33324 • 954-765-4400 • broward.org/building
CONTRACTOR REQUEST TO CANCEL A PERMIT
If a Contractor wants to cancel a permit, he/she shall submit proof to the Building Official that the owner
of record for the permit has been notified. Proof shall be either a copy of a certified registered letter and
return receipt received by the owner, or by a notarized letter from the owner stating that he/she is aware
of the cancellation of the permit and has no objection to the request. In addition, the Contractor will
send the Building Official a letter stating that the Building Official is held harmless from any legal
involvement. Upon receipt of these documents, the existing permit will be cancelled after a field
inspection has been completed.
If a Sub-Contractor wants to cancel a permit, the same procedures apply, with the exception that the
Sub-Contractor must show proof to the Building Official that both the Contractor and the Owner of
Record have been notified and have no objections. The Sub-Contractor will also send a letter to the
Building Official stating that the Building Official is held harmless from any legal involvement.
(form is on reverse side)
Broward County Board of County Commissioners
Mark D. Bogen • Beam Furr • Steve Geller • Dale V.C. Holness • Nan H. Rich • Tim Ryan • Barbara Sharief • Michael Udine
www.broward.org
CANCELLATION OF PERMIT BY CONTRACTOR
Date:
Permit Holder:
Permit #
Name:
Address: City: State: Zip
Phone # Cell #
Reason(s) for Cancellation of Permit:
Signature of Permit Holder Date:
Sworn to (or affirmed) and subscribed before me by means of
physical presence or online notarization, this ____ day of _______, ____ (year),
by ____________________ (name of person making statement)
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Broward County Board of County Commissioners
Mark D. Bogen • Beam Furr • Steve Geller • Dale V.C. Holness • Nan H. Rich • Tim Ryan • Barbara Sharief • Michael Udine
www.broward.org
Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION/BUILDING PERMITTING
1 North University Drive, Box #302 • Plantation, Florida 33324 • 954-765-4400 • broward.org/building
STATE OF FLORIDA- COUNTY OF BROWARD
Sworn to (or affirmed) and subscribed before me by means of
physical presence or online notarization, this ____ day of _______, ____(year)
by ____________________ (name of person making statement)
_____________________________________________________________________
NOTARY as to Property’s Owner Signature
Name and Title (printed) ________________________________________________________
(Type/Print Notary's Name)
Personally, known or Produced Identification
Type of identification produced
____________________________________________________
Identification Number: __________________________________________________________
Florida Statute(s) 489.103(7) and 489.503(6): A violation of this exemption is
a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1 ,000.00 fine in addition to any civil penalties.
In addition, the local permitting jurisdiction shall withhold final approval,
revoke the permit, or pursue any action or remedy for unlicensed activity
against the owner and any person performing work that requires licensure
under the permit issued.
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CONTRACTOR REQUEST TO CANCEL A PERMIT (Broward County)

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Completed 27 August 2020

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