140 16th St - Termination of Building Permit By Property Owner - 17-RAAR-3851 TERMINATION OF BUILDING PERMIT BY PROPERTY OWNER
am the owner of
and have
contracted with 4 for
improvements on the above property, unde Building Permit �7" r 38S
I have terminated my contract with the above contractor, before completion of the project, and
wish to transfer the Building Permit to
I understand that financial and contractual issues may still apply and are civil matters between
the owner(s) and contractor(s) and we agree to hold the City of Atlantic Beach harmless in
those matters.IV---
Details(Optional)
A copy of this form will be sent to the original contractor.
Property Owners Name / Phone Number
Address
Signature of Property Owner Date
Before e thisday of 54 v^-e. 201-1
Personally appeared a A V-e ;, I'�-'an 'g;i c4r
Signature of Notary Public
[] Personally Known:
GRACE MACKEY roduced Identification:
MY COMMISSION#GG 042989
a k
EXPIRES:October 27,2020
Bonded Thru Notary Public Underwriters
Twp_ ��, .