HomeMy WebLinkAboutSubcontractor agreementPERM!T#!SSUEDATE
PLACING & DE١^LOPMENT SERVICES
Building & Code Compliance ٠1ฬร10ทΛ؟CountyسهFLORt.DA
BUILDING PERIT
SUBCONTRACTOR AGREEMENT
Liaison Consulting Group Inc have agreed to he
(Company Namedndi^dual Name)
ه0 e!ectrical contractor Sub-contractor for Atlantic Seawall
(Type of Trade)(Primary Contractor)
For Ле project located at -an Dr Jensen Beach, FL 33497
(Project Sfreet Address or Property Tax ID #)
It is understood that, if there is any change of status reg^ding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be ad١tised pursuant to the
filing of a ؛e of Sub-contiactor notice.
CO)،CTO)SIGNATURE SUB-CONTRACTOR SIGNATURE (Oealifier)
Adam Winslow1DîIkI^îÇ{
PRINT PRTOTNAME
EC-13٥073S7
COrøTY CERTIFICATION NUMBER
State of Florida, County of/h/9¿77/¿J
The foregoing instrument was signed before me this day of
who is personally known ¿_ỹx has produced a-
as identification
COUNTY CERTWICATION NUMBER
State of Florida, County of P/íÍm ^ f Ể*Ị/K
The foregoing instrument was signed before me this ^^day of
by ťVdLaw-»4UVML\óM
I
who ئ personaBy Imown .or has produced a
as identification.
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؛Rerised 11/16/2016
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All APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:Date:
4ت ه ج٠Ε ج ج ع-у Buỉídỉng Permit Applícat؛on
Planning and Development Sendees
Building and Code Regulation Division
23>ω Virginia Avenue, Fort Pierce FI Β4982
Phone: (772) 462-1553 Fax: (772) 462-1578
ResidentialCommercial
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 8732 s Ocean Dr Slip 11
Propel Tax ID#:
Site Plan Name:
Projert Name;Ma
Lot No.
Block No.
ster PM#2101-0317
DETAILED DESCRIPTION OF WORK:
Install power to new boat lift ftom existing marina distribution to include wire of (2) 2hp motors
New Electrical Meter Second Elertrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that appl٧:
_Gas Piping
— Sprinklers
Mechanical GasTank Shutters
Elertric Plumbing Generat
Windows/Doors Pond
Roofor Pitch
Total Sq. Ft of Construction: -
Cost of Construction: $ 3-000
So. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:CONTRACTOR:
Name:Adam Winslow
Company:Liaison Consulting Group Inc
Address.388 Paulus ct
Name
Address:
Citt^:
Zip Code:.
Phone No.
E-Mail:
State:
Boca Raton State: FLFax:Ci^:
Zip Code: 33486
Phone No(581) 376-4124
E-Mall!nf٥@lcgc٥nt٢acto٢s.com
State or Coun^ LlcenseEC-٩3Q07387
Fax:
Fill In fee simple Title Holder on nert page ( If different
from the Owner listed above)
If value of construction Is 25.0 or more, a RECORDED Notice of Commencement is re quired.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTJ٥N UEN lAW!NFORMAT!٥N:
DESIGNER/ENGINEER:
Name:
Address:
C!^:
NotApp!icab!e MORTGAGE C.MPANY:
Name:
Address:
NotApp.lcaWe
State:City:State;
z!p:Phone Zip:Phone:
FEE SIMPLE T١Tl£ HOIDER:
Name:
Address:
Not Applicable BONDING COMPANY:
Name:
Address:
.Not Applicable
Ci^:.City:.
Zip:Phone:Phone:Zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
ا certify that no work or installation has commenced prior to the issuance of a pemiit.
1 ؛آل1؛المت псоп^1«ак؟Г٥ repre|Şentfti^ tha^s grantig a permit พ111 a^t^orize the permit holde^to build the subject structure
which ؛gn^on^ictwithj^ny^^pplicafale'Ho^e Own^s Associatlon.rules, bylaws^raj^covenantsthatтЭу res^rřc؟or prOhiht؟^hstructUrC. Pleas¿ consul^th your Home Owners Assocfa٥íón and revfew٧^our deed formany restrirtfons which may٥apply.
!n consideration of the granting of tills requested permit, I do hereby agree that I will, in all resperts, perform the work
In accordance with the approved plans, the Florida Building Codes and St. lucie Counfy Amendments.
The following building permit applications are exempt from undergoing a full concurrency review; room additions,
accesso^ struchjres, swimming pools, fences, walls, signs, screen rooms and accesso^ uses to another non-residentlal use
WARNING TO OWNER: Yourfailure to Record a Notice of Commencement may result in paying twice for
!m؟royements tọ your ۶rope٩. A Notice of Commencement must be recorded in thepublic records of St.
Lucie Coijnty and posted 0ทฺ the jobsite before the first Inspertion. If you intend to obtain financing, consult
with/encţer or ไเ attorney before commencing work or recording your Notice of Commencementr
-Sigπatцا Signée of Contractor/License Holder
ST^EOF FLORIDA STATE OF FLORIDA
COUN^OF
Sw^^r affirmed, ه3ا Presence or -
this L٦^jav of 2020 ىبد by
and subscribed before m
.ل ر/n/()
ร7ๆ to (.or affirmed) and subscribed before me of
physical Pres^æm; 3>!ท6 Notarizationthis
e of
online Notarization
7
11ť/٧ f¿-ADIiJSLOW
Name of person making statement.Name of pereon making statement.
Personally Knowm
Type of Identification
Produced
OR Produced Identification Personally Known
Type of l.ntification
Produced
OR Produced Identificationê
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REVIEW
٤
-
REVIEW
Commission No.
---٠ ٠A اءر
(Signature ol
73213 ComSilon # HH -;17.20 ةذي ρ My Comm. Expiresί١؛..ΐ؛·
Commission إ0.Nol
REVIEWS FRONT
COUNrtR
PIANS
REVIEW
VEGETATION
REVIEW
SEA TURTIE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPICTED
-
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