HomeMy WebLinkAboutSubcontractor Affidavit, electricalPERMIT#
PLANN
Bu
ISSUE DATE.:
G & DEVELOPMENT SERVICES
ing & Code Compliance Division
BUILDING PERMIT
B-CONTRACTOR AGREEMENT
L. Walton Electric, Inc. have agreed to be
(Company Name/Individual Name)
the Electrical Sub-contractor for D C Construction & Company, Inc ..
(Type of Trade) (Primary Conti-actor)
For the project located at 7404 Deer rk Ave, Fort Pierce, FL 34951
(Project et Address or Property Tax ID#)
ft is understood that, ifthere is any ch ge of status regarding our participation with the above mentioned
project, the Building and Code Regul t n Division of St. Lucie County will be advised pursuant to the
COUNTY CERTIFICATION NUMBER •
State of Florida, Co~nty of :J;.,J '"-'"' (l tV
The foregoing instrument was signed before me this
tx C(.,~ ,20~ by-=l)=A=~'-'-'·, :L.-l"-=-=.::+-11!-L'--'~~,-..
who is per.sooally known / or has produced•-~,-----
STAMP
Revised 11/16/2016
.,:.;~:;A~¥~~~-.. APRIL LESPERANCE . ..-' .. A'\.; Commission# GG 193362
: \~~~} Expires March 7, 2022
·· ·•,,i!r.i.~,,,· Bonded Thru Troy Fain Insurance '7019 . ,., ..... -----------.... +-...r
-ONTRACTOR SIGNAT URE (Q ualifier)
lorn f;. lf.\U \ ¼ .
PRINTNAME
COUNTY CERIIFICATION NUMBER
State of 1'1oridll, County of · truiW. ~W
The foregoing in,trurnent w.s signed before me this \* day of
t:&e~ · · . 20~ by "lbmf. ~ ti;:-.·.
who is persoually known ✓or bas pr~d~,d. ___,,,h'+,/.:.~'----
as identification,
~ 0 //1?." .. ti/0,£ I «Mttt.__ STA111P
llign~re of Notary Public
~c-)\ h&lu'{l\(),c,, int ame of Notary Public