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HomeMy WebLinkAboutSubcontractor Agreement PERMIT# I 1 Q 1 ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division i BUILDING PERMIT SUB-CONTRACTOR AGREEMENT St.Lucie County Contractor Certification Number: State of Florida Certification Number(if applicable): E42 /306 � 95 9 pmz� / / I� Aaaz' hit4 have agreed to'be the A:=ual Name) Sub-contractor for v &nAw4c, ) of Trade (Type ) (Primary Contractor For the project located at y (Project Str t Address or Property Tax ED#) 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 Cou &LV� .QED Change of Sub-contractor notice. (Form: SLCCDV(No.004-00) FEB 17 2017 BUSINESS-QUALIFIER -(Name of the Individual shown on the Contractor's License) PERMITTING St. Lucie County, FL NOTARIZED SIGNATURES ARE REQUIRED • Business Name: nn • ddress- City/State/Zip: - hone: 7 email: /1'I i!'� ��IlI08 Q.L�.b`�`1`�s�.rQ •G�Oih r�t;�h�1 ;� rs i I TURE PRINT NAME DA E STATE OF FLORIDA,COUNTY OF �- E FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS��DAY OF �/ BY t " �i1(�� d P_V-"d�_ WHO IS PERSONALLY KNOWN V/ OR HAS PRODUCED AS IDENTIFICATION. DA%(MWkNWND PRUE NOTARY PUBLIC SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC STATE OF FLORIDA SLCPDS: 08/06/2014 , x FF192675 Expires 1/26/2019 PERMIT# i , a -UoZ l^ ISSUE DATE ___ PLANNING & DEVELOPMENT SERVICES 711 Tt -�' ' Building & Code Compliance Division - BUILDING PERMIT RECEIVED SUB-CONTRACTOR AGREEMENT FEB 17 2017 PERMITTING St. Lucie County, FL JL,-,-4 Ah i l k n f UL have agreed to be (Company Name/Individual Name) the N f LonA41oil,ne Sub-contractor for (Type of Trade) (Primary Contractor) For the project located at NO-4 J i21 1-rs NA (Project Street Address or Property Tax ID#) I 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. CONTRACTOR SIGNATURE(Qualifier) S[;y --CONTRA O 9 (Qualifier) 6' ( � (,C�LlMS J G►Me J j,�fcltt�,i� PRINT NAME PRINT NAME COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER State of Florida,County of State of Florida,County of T e foregoing instrument was signed before me this day of The foregoing instrument was ed before me this day of 0P y I 20�b I iho is personally known or has produced a who is personally known_or has roduced a as identification. aid tification. I STAMP STAMP ig ture of Not Public S' a re of Notary Public Tint Name o Nota Public Print Name of Notary Public , I ANG7#FF Notary Publ e LASHAHNA Commiss4730% My Comm.EFlorida7,20i9 ma's Notary Public State of Flon_:. Revis 1%Yc�t�plbp�� Bondedthrou through Assn "r :Q°My Comm.Expires Dec 2 g � 4 �•, o;` Commission#FF 17749 Bonded through National Notary Assn.