HomeMy WebLinkAboutGas Sub Authorization FormPLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
,Gas /Ge-/y
have agreed to be
(Company Namefindividual'Name) —
the Gar S Sub -contractor for C�'(W kc L i
(Type of Trade) (Primary Con or)
project T Cu �C{ � by V oK � o L/ e- -.. 3 LAM6
For the ro'ect located at �
(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
a
Id' d Code Reguiadon.pivision of St u 'e County will be advised pursuant to the
e of Sub -contract
SIGNATURE (Qualifier)
ChS%VV1 'r- gyp.Eton
PRINT NAME
.�I � b
COUNTY CERTIFICATION NUMBER
State of Florida, Conaty of
The foregoing instrument was sipW before me this _ day of
20_, by
who is personalty !mown _or has produced a
as Identification.
STAMP
Signature of Notary Public
Print Name of Notary Public .
Revised 11116/2016
G Q-q-o -*
COUM CERTIFICATION NUMBER
State of Florida, County off L►1 JL
`TThthe, foregoing instrument was siped before me thie@aday of
who is personally known or has produced a
VY
~01—
zs identin +a+ Notary pubes S
Ang0* M Boom
MY Cor+wl _
—
5i2c!atare of Notary n c
t\f r^
PriatName,ZNotaryPablic