HomeMy WebLinkAboutSubcontractor Agreement PERMIT# SLC 2012-0492 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
if
- BUII.,DING PERMIT
SUB-CONTRACTOR AGREEMENT
Eastern Electric Service, Inc. have agreed to be
(Company Name/Individual Name)
the Electrical Sub-contractor for Coastal Development Corporation
(Type of Trade) (Primary Contractor)
For the project located at 7964 Plantation Lakes Dr, Port St. Lucie, FL 34986
(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.
CONTRACTO GNA (Qualifier) S O CTOR SIGNATURE(Qualifier)
55,�,'_v Kevin Smith
PRE14PNAME PRINT NAME
5 j 18563
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of State of Florida,County of
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this I day of
S'2!� ,20 »y �lX.p,T nib]j C`C7 zob?by
who is personally known or has produced a V o is personally known or has produced a k
s—
as identification. as identification.
STAMP STAMP
Signature of Notary Public Signature of Not b c
Print Name of Notary Public Print Name of Notary Public
• Corlene Edlund-Chen
s
sq, Notary Public
Revised 11/16/2016 —State of Florida
?Comm#HH006747
9 Expires 7/13/2024
PLANNING'& DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
COUNTY2300 VIRGI 41A 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
yor information and signature. A new Notice of Commencement must be filed in the new contractor's name
values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to
ing any work.There is a$50.00 fee for the Change of Contractor.
HANGE 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 PERMIT—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: C), J I ��� Permit Number:
Site Address•
r
`+ :CA_ State License r SLC License 6
Original GC,subcontractor or ownerlbuilder
�5_rn State License SLC License-122
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATUKE OF OWNER or owner/builder) V SIGNATURE GENE CONTRACTOR(or new GC,as aCCpplicabl )
PRINT NAME / Z �i S k— �+ ��iF'K1N 1'NAME1 A '�_rJ �.fl� J !� J'
State of Florida,County of St Lucie County State of Florida,County of St Lucie County
The following instrument was acknowledged before me this The ollowin nt was acknowledged b fore me this Q�
day of��20�y — /
day of ,20_�by ,
who is personally known to me who is personally known to
or who has produced as ID. me or who has produced F ' .
Signature of Notary Date Signature of Notary Date
Revised 04/15/16