HomeMy WebLinkAboutSub-Contractor AgreementST. LUCIE BOUNTY PUBLIC"VORKS 4.}}�o
BUILDING & ZONING DEPARTMENT-�`'2 /O /0-2%-<"
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BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number. 4_10 52(q
State of Florida Certification Number (if applicable): -0 0000
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biz 14L L 16Q , ;64_ �17 �� A' has agreed to be
(companyfindividual name) 7
the i0P.C'i6;!c,p Z sub -contractor for
(type of construction trade) (name of the prime contractor)
for the project located at W '9 SA )-Uy6'0 -AnIlk . It is understood that,
(street address or property tax ID #)
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 personally filing a Change of Contractor
Form (SLCCDV FORM NO. 004-00).
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BUSINESS QUALIFIER (original signatures required):
signatur Print name Date
business name: Py?,�Z�%�r}tvi�/__ Serv✓, ��'���1 hl.
address: '76 y %Z�'✓��' G
city,state,zip: on,� S` Lvr ��L�i..pzI9�T�
phone: SG1��75'-bb17 - S�J f79-3So�
OFFICEUSE?ONLY:
PERMIT # ISSUE DATE
SLCCDV FORM NO.: 002-00