HomeMy WebLinkAboutSUBCONTRACTOR AGREEMENTPERMIT # ISSUE DATE
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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable):
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V h P_ ` S U D c o r-t *v-oi cA-o r s 27 JG . have agreed to be the
(Company Name/Individual Name) pp
roNC 2. e�c Sub -contractor for {a AJ � � � a= E
(Type of Trade) (Primary Contractor)
For the project located at o u Ems'y A lJ rj 4 o i a-T"
(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, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a
Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURESS ARE REQUIRED Business Name: CJ �i l I SL) C p try, C-ky ,(� S 271
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Address:
City/State/Zip: )C7'% P.A.GC 3 C/ 9 8 Z
Phone: /%%d LA U— 9,CO Z email: bob r-e- . j b&,Y,5"6ci _A . A6*
SIGNATUIZE PRINT NAME DAT
STATE OF FLORIDA, COUNTY OF S I 4-1 C,I
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS _�Z DAY OF 20 U�
BY �`� _ �`e,�/`WHO IS PERSONALLY KNOWN OR HAS
PRODUCED AS IDENTIFICATION.
(STAMP)
SIGNATURE OF NOTARY PUBLIC J� 6 off o►i-
SLCPDS: 08/06/2014 "' "''� ' ` 41" 27, 2018
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116704
PARTIAL LIEN WAIVER AND RELEASE
(Concrete Structures Agreement)
Exhibit "C"
STATE OF FLORIDA)
COUNTY OF )
WHEREAS, the undersigned, Shell Subcontractors, Inc., (hereinafter the "Contractor"),
having contracted with K & M Properties of Florida, LLC, to perform concrete paving, material bin
footings, dumpster walls, pipe bollard installation and drop curbs work for the construction of a
concrete block plant (hereinafter the "Project") on the property described as follows:
8000 Allegiance Court, Groveland, Florida 34736, being more particularly described as:
Parcel Identification)Number 20-21-25-120500003300, and
Parcel Identification Number 20-21-25-120500003400;
Lot 33 and Lot 34, Lake County Central Park Phase 2, according to the plat thereof
as recorded in Plat Book 40, Pages 84 through 87 as recorded in the Public Records of Lake
County, Florida
(hereinafter the "Property") owned by K & M Properties of Florida, LLC (hereinafter the "Owner"),
for good and valuable consideration in the amount of $ which
is the amount sought by Contractor in the Application for Progress Payment being submitted by
Contractor along with this Partial Lien Waiver and Release, hereby waives and releases in favor
of Owner, any and all lien, right of lien or claim of whatsoever kind or character on Property on
account of any and all labor, services, and/or materials furnished for or incorporated into the Project
through the date of , 200_.
SIGNED this _ day of , 200_.
SHELL SUBCONTRACTORS, INC.
By:
Print Name:
Its:
SWORN TO AND SUBSCRIBED before this day of , 200_, by _
, as of Shell Subcontractors, Inc., who is known to be
the person who executed the foregoing instrument, and who is personally known to me, or who produced
the same as his/her free act and deed. as identification, and acknowledged that he/she executed
Notary Public
My Commission Expires:
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY TSQ ` \ \ will be using the following sub -contractors for the
(Company/Individual Name)
project located at l
(Street address or Property Tax ID #)
It is understood that if there is any change of status regarding the participation of any of the sub -contractors
listed below, I will immediately advise the Building and Zoning Department of St. Lucie County.
St. Lucie County/
Trade
Name of Company/Contractor
State of Florida
License Number
Electrical
�0I �� � 3yQ�
Plumbing
1
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ie
HVAC/
( C
Mechanical
L` q
M01
QCc) ALI
Roofing
Gas
1 To
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OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
72
Revised 07/29/2014