HomeMy WebLinkAboutSub-Contractor AgreementPERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & .Code Compliance Division . ,
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor. Certification Number:.e.,
State of Florida Certification Number (If applicable): \
have -agreed to be .the'
(Company Name/Individual Name)
Sub -contractor for
(Type. of Trade).. (Primary Contractor)
For the proj ect located at \��k\
(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 SIGNATURES ARE REQUIRED
Business Name:
Address: �,��wla�
City/State/Zip: 0��-,(aQ,*\ZQ_L
Phone: - l� ' . email:.
SIGNATUO PRINT NAME DATE
STATE OF FLORIDA,: COUNTY OF.
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF _c , 201
BY �cAv�� V Ac�C WHO IS PERSONALLY KNOWN FOR HAS
PRODUCED AS IDENTIFICATION.
(STAMP).
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS: 08/06/2014
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MHUNiERPublic - State of Florida
. Ex ires JanoFissio ` .. 2015rou n #.EE ,+1278_
9� NMona, N;), Assn.
PERMIT # ISSUE DATE