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 | BUILDING PERMITTING
2307 West Broward Boulevard, Suite #300 • Fort Lauderdale, Florida 33312 • 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 • Lamar P. Fisher • Beam Furr • Steve Geller • Dale V.C. Holness • Nan H. Rich • Tim Ryan • Barbara Sharief • Michael Udine
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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CONTRACTOR REQUEST TO CANCEL A PERMIT (Broward County)

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Completed 8 February 2021

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