HomeMy WebLinkAboutPermit #2012-0610 @ 13505 NW Wax Myrtle Trl - Cancellation of PermitPLANNING & DEVELOPMENT SERVICES
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- BUILDING & ZONING DIVISION
COUNTY ,
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 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,
and the new contractor of record for the 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 submitted 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 fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
" CANCELLATION OF PERA41T — 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: JUNE , 2021
Site Address: 13505 NW WAX MYRTLE TRAIL
GRANDE CONSTRUCTION OF FLORIDA, [NC -
Original GC, subcontractor or owner/builder
NIA
New GC, subcontractor
Permit Number: 2012-0610
License CGC1505127 SLC License 23758
License SLC License
Reason for Cancellation OWNER CANCELLED PROJECT TO SELL HOME - NO WORK COMMENCED
The undersigned does hereby agr e t?Oipdtemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees o amages arising m and all claims of action for any reason, which may arise as a result of this change of
contractor/ bcontr ca ce ' ion of permit. A permit cannot be cancelled if work has been performed.
'
SIGNA OF O NE o ui der) 16E GENERAL CONTRACTOR (or new GC, as applicable)
PRTNT
GALLO, OWNER
State of Florida, County of St. Lucie County
The follpwing insvm ent was acknowledged before me this
025ay of /202 , by
personally known me
�who has produced as ID.
� (C; J NFA2021
Lary Public State of FkMa
Amy E. Scat
64V
Commission Hhl 124378
expiresOW0212025
PRINTNAME GREG OLDAKOWSKI, PRESIDENT
State of Florida, County of St. Lucie County
The following, instrument was acknowledged before me this
21 fr day of _TV09 — 20ZI , bybIF OUwkAY 1te1
his personally kno
Nr
whohro uced as U
J�INEZ1 2021
Notary Date
Notary Pubile state of Florida _ ~
I Amy E. Scott
commission HH
y�� F�icPIMS OW0212026 124378