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Home My WebLink About2104-0333 Subcontractor FormsPERMIT # ISSUE DATE 1 � •air �_ PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT a '�i 2a o ys P. ., ill4we have agreed to be (Company Name!(nZdual Name) the o LAZ M a r.✓a _ Stab -contractor for 14, -4\) ra 1♦ (Type of Trade) (Primary Contractor) For the project located at N (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice. 1 1 CONTRACTOR SIGNATURE ( u BRer) PRIIYI' NM�tE COUNTY CERTIFICATtUN NUMBER State of Florida, County of Oa. it The foreping instrument was stilted before me this \_ day of _21,, by 1V -Mi. Fi�:v IAe�A -who is personally uno-na=gy known .�Lor has produced a m identlf y� STAMP Signature of Notary Public 1�v • .' "c`l � er Print Name of Notary Public 'iF``'? ` ro�r Vueec Sate c' r c�N -_��y ynm145MnarF :51i" _ T Y, :omen. EaarlS rK 1' 2Q7: ResRl2W9T/9"1P'•. sere. av O C R SIGNATURE (Qualifier) PRINT 2no y /n E-12 NAME AU3u COUNTY CERTIFICATIOP NUMBER1 State of Florida, County o 'ALL(,\-� The regoing instrument was s `ed berare a this l \ Q� day of 20�3 by who is personally (mown _or has produced a4 k(N t Az Uqh 2 Ia'WID��Jtai'I x�I.�`t{P B. JEWELL A C - State of Florida Commisslon 0 GG 937394 Comm. Expires Dec S. 2023 PERMIT d ISSUE DATE I PLANNING & DEVELOPMENT SERVICES > > Building & Code Compliance Division a aG11.111NG PERMIT SUR-CONTRACTOR AGRF.EMEN I Don Green Electric LLC/ Don Green _ — — haw agruLd lit he I-7m n) Name Im1i1Ww1l Nante) the Electrical Sub-contractur li+r Nathan Hayford I rinwn Contractor) For the project located at 2465 S. Brocksmith Rd. / 2303-501-0024-010-4 - Ihl vicct Street Az -' IN 1'ldpen\ Iu% IU rr� It is understood that. it'Iherc is am change ol'status regarding our participation eith the above nlentiunwd project. the Building and Cale Regulation Division ol'St. Lucie Count% %%ill he adviad pursuant to the tiling of a Change of-Sub-conlructur notice. +Ir%Ilt \rTf1I1�V 1 �- _ Nathan Hayford �"�Q� IOI\I% / "E7tl till"%II(BN %late of I106112.( Ynnb wr Q':S'O 1 M1r h.c¢uind in./rnmcnl was aiEned hrfwrr mr thla _ Jxl of +n�,m N iiarsA �-i0.1f-G.r� wha Is pe"I"all: buunn 120m hY. pradored a at tdrnhrr, \innomrc of �.Ixn ruhlir GV�cL_�I`la-\1 -- - -- hint �mte af�rtmn Pal{ic ys• `. EVM ?o,�'-eT�1�a'jt-[i, - YYr _ C:taonnmnamm�n. rMENKxmpknAsn(.L fI*.e.eA D(KERe2YPIK"S2:P wr=11M 1 � Dow N 14( 11�Igiii (lit %if%%II NIIVtts ifirrl Don Green PRIM ♦ \%fi----- -- ---- -- ---- GL3o O ' Slot 7 _..— _—. f of ♦I% (LNI IEI( %1111% ♦1 %m slats of I [.rids. l .nnn of �j i r L }) • i I lit fit, ".4ne m'Irment was aimed Iletnn k Ihia l y,. daa nl Jbl—._b1L. lea Q(-1 l'-�i:r 'r•I_ w huispmnnalh l.nuwnwr has prWuW a- a. Wrnllncob.n. MEPabre t{\wbn I'uM1lk L- Print 1mr xl \elan Public �..•••., LAURIE PHILLIPS %��'•�'rSNotary PYb1,CStale of Flm.da `s F�i�l� Commlauon a Hit 87881 = MV Cmmnl{sldn E.u.es February 01.1025 PERMIT # ISSUE DATE COUNTY F L O R I D A PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT �ny►r�C'oo� LLC /boo (Company Name/Individual Nam ) the MCCh0Lf)tC k (Type of Trade) Sub -contractor for Nathan Hayford (Primary Contractor) have agreed to be For the project located at 2465 S. Brocksmith Rd. / 20/35S/39E 2320-501-0024-010-4 (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice. Nr fll�l r�lA�1 64l- v` CO TRACTOR SIGNATURE fifier) Natha Hayford PRINT NAME 1WI1 \2 0",�2 COUNTY CERTIFICATION NUMBER State of Florida, County of Pasco The foregoing instrument was signed before me this 5� day of \\ 20Z_.by'�LMInM )AMSM3� who is personally known�or has produced a as identification. / -/Jl., t' \ / 11 f.A A A Fes/ , M r-v— STAMP Signature of Notary Public Karen M Griffin Print Name of Notary Public CLZI� SUBCONTRACTOR SIGNATURE (Qualifier) fl T)Cd ) i A F lAI PRINT NAatE COUNTY CERTIFICATION NUMBER I State of Florida, County of gr ev t>r L+ The foregoing instrument was signed before me this , day of U rll 120171by DGVIA (3 UU0bzt-et who is personally (mown _or has produced a as identification. fin` �f C� Q 1) E i l CAD-S STAMP Sigaa�re of Notary Public Soar, ()-DeNa44os Print Name of Notary Public �,tn Notary Publie State of Ron" Karen M Griffin te d Flonda y' My Commnawn GO 160249 Riff oaqq wd% E,rawa 11/urs021 GG 3°°`'�tRevised1111629 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF IN FDRMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERISI. AUTHORIZED I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyr,") must have ADDITIONAL INSURED Provisions w I S Off"10 sad. I If SUBROGATION IS WAIVED, subject t0 the terms and Conditions of the policy, certain policies may require an endamemewL AstdWNM On i ass certificate does not confer rights to the certificate holder in lieu of such eerKlorrsemenl e . IJ Metres blslrrEnee Agency I a,, e,7 I407) 273-0230 - _ _... _. (I K. Na(: IOduldo, IFL 320DT g:InfO�Jmeyers.eom INSURER AFFOI�Ia COVERAGE_ -_ MAIGN I _. .s r o a�_Soufharn Owners lnsura-nce Co- 1 f�1g0 .__ a, auaENa:Aut0.OWners Ytsurance Compalry lam Envivacool LLC N-suRERC:NerkN insurance CO --- .- _ .Y38970 a46 W 10no St R307 Ag0_RIRol Caeca. FL 32926 Pu MIER E: er,nelnu unuaCo- COVERAUEZ {=m I Ir1 IC IRVm- THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSLED TO THE INSURED ' NAMED ABOVE FOR THE POLICY PERIOD THIS 13 TO CERTIFY INDICATED. NOTWfTHSTANDING.A,NY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN D SUBJECTTOALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - _POLICIES. 1118R ME�eWInANCE '�--1 POIICV NUMBER F[NlCY 13F I PUIR.'/EI� UNITS A X catww.FxcGlaleeAL tuewry - EACH OCCURRENCE T 1,000,000 300,000 ° CtANaMADE I X1 OCCUR 54057 �ii 4111f20Y1 4111R022 ,s rcar®ou § 10,000 o,ElAny v+�eay §-- ar�r.� 1.000,0001 2.000.000 'TE UNIT APPLES PER: - PQVTLDUCY I J %r F L� GENERAL GATE PRmucre=mNrnm AG0�2,000.000 General Aggregate gTH. B AurorloaeuAesnY ��a�o�®sexxEtaar § -- 500.000 ANY AUTO 115406700 7111Y2021 712MM IleooAY_awgrSP_>-1. A-_---'---- 6"Ly x A�S�CUppryrory.�DDs°WYUyLN�1EFEOpp Pw LYIwUoRYIPw*zidPvJ I - H°Ni . IWfOa ONLY AU a NLY UMRE LALYIe OCCUR EACH OCCURRENCE i 0(cos LMe uneRs-NADe ALfgREGATE _---- _ — - DED RETENnoNS C xlmDmtxlr rroRXERS COMPENSATION AND EMPLOYERS lLU16RT YIN VWC0130519.04 611012021 8H31M .. _ f 100.000 a'r N 'Enxa�Tu r�rn>BwnvE I I MIA E EAOIIEm eT-_.YEES 100.000 EA - -_ Ol3Cl�imrl OF OPERA EL.OLSEASE-POLICYLIIIr 50e, I °E MPTI°NGFOPFAATIONa ILOunG IYF3ECLEa(ACORDRD1.A4daaWRemrlu ScRrINb..eyfw a1bcMaNa.,pR.M,puYM) i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, St.Lucie County ACCORDANCE WITH THE POLICY PROVISIONS. NOTICE WILL BE DELIVERED IN 2300 Virginia Ave. FL Pierce, FL 34982.5652 A(/UT/1g�yR®�REPRESENTATIVE 1/ ACORD 25 (2016103) O 1911a-2015 ACORD uvKrONA i iV N. AR rgnts mearvea. The ACORD name and logo arc registered marks of ACORD