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Home My WebLink AboutSub Contractor Summary forms 3.11.2021 (�/az_zl PLANNING AND DEVELOPMENT SERVICES DEPARTMENT Building and Code Regulations Division BUILDING PERMIT B-CONTRACTOR SUMMARY will be using the following sub-contractors for the t(e o pany/Individual Name) 61 project located at 4805 WaterSOrlg Way (Street address or Property Tax ID#) It is understood that if there is any change of status regarding the participation of any of the sub-contractors listed below,I will immediately advise the Building and Zoning Department of St.Lucie County. St.Lucie County/ Trade Name of Company/Contractor State of Florida License Number Electrical ` l 3 1 aR q Plumbing Master Plumbing 27366 HVAC/ AC Care 31900 Mechanical Roofing Micheal Kevin Walsh Roofing 28578 Gas Como Gas 05594 27064 OFFICE USE ONLY: PERMIT ISSUE DATE: NUMBER: Revised 07/29/2014 PERMIT# ISSUE DATE I� _ PLANNING & DEVELOPMENT SERVICES • = - Building & Code Compliance Division BUILDING PERMIT SUB-CONTRACTOR AGREEMENT � , have agreed t be (C mp y Na Andividu Name) the �� Sub-contractor for L L (Ty�e of Trade) (P ary Contractor) For the project located at (Project Street Address or Prope Tax ID#) It 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. NTRACTOR SIGNATURE(Qualifier) UB-CONTRACTO NATURE(Quali ) PIM NAME T PRINT NAME COUNTY CERTIFICATION NUMBER /CCOUNTY CERTIFICATIONNUMBER State of Florida,County of p"rAffl- State of Florida,County of Ah (k' he foregoing instrument was signed before me this day of The foregoing instrument was A ned before me Jo day of 201,byJb4Yll� � � � ,2al,by who is personally known_or has produced a who is personally known or has produced a as identi reation. as iden ification. STAMP STAMP /Vignatu a of Notary Publi Signature of Notary Public / Print 14ame of No Notary Public State of Florida Print Name of Notary Public Frances Dona c s My commission GG 092440 Nosy public State of Florida a n Expires 07/27l2021 R Frances Donalyly Commission GG 092440 Expires 0712712021 Revised 11/16/2016 PERMIT# ISSUE DATE a . --;�,- ,� �,�p-,_;�••_, PLANNING & DEVELOPMENT SERVICES Building& Code Compliance Division COUNTY BUILDING PERMIT SUB-CONTRACTOR AGREEMENT Wds b have agr ed to be (Com any ame/Individual Name) the Sub-contractor for (Ty e of rade) rimary Con acto project r) For the ro'ect located at t/ D (Project Street Address or Property Tax ID iu It 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. /tVNTRACTOR SIGNATURE(Q fer) NT CT R SIGNATURE(Qualifier) II/V I(-,A/J-e f a RINT NAME ` PRIN AME c4_, - /_ Jy �j GCc l3 3CX) < COUNTY CERTIFICATION NUMBER n &__OUNTY CERTIFICATION ER State of Florida,County of �L y State of Florida,County of Thee foregoing instrument was signed before me this day of The f regoing instrument was sign fore meefthis ,day off 202\by X.�1C� 2d/by who is personally known`�or has produced a who is personally known v or has produced a as identification, as identification. ___4V'W ZA4— STAMP STAMP Signature of Notary Public Signature of Notary Pub is Print PKMEI Print Name of Notar Pu li blic Sts;e of Florida Notary Public StA&of Flcnda Dorua mission GG 092440 R Frances DOW'7/27/2021 My Commission GG U9244G ?�f�c Expires0712712021 Revised 11/16/2016 PERMIT# ISSUE DATE PLANNING & DEVELOPMENT SERVICES • J - Building & Code Compliance Division sigh BUILDING PERMIT SUB-CONTRACTOR AGREEMENT MCIL have agreed to be (Company Name/Individual Name) /f the HVK, Sub-contractor for I MIWAIWWA&V all (Type of Trade) / C (rem ary ontractor) / For the project located at `7'�D�.1 /I A-Z (Project Street Address or Property T 6 ID#) ff It is understood that, if there is any change of status regarding otlr participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the tiling of a Change of Sub-contractor notice. )ZINT L"CTOR SIGNA-1.1'RE(Q lifier) StIB-CONT 5 CTOR SIGNATURE(Qualifier) NAME: PRINT NAME 2.It� - /�a3gs 3Ag00 COUN'rl'CERTIFICA•IION NUMBER COUNTY CERTIFICATION NUMBER State of Florida,Counh of��i� —tIUCIw State of Florida.County of,^ak+'n Abe foregoing instrument was signed before me this day of The foregoing instrument ryas signed before me this ZY day of who is personally known v or has roduced a who is ersonallll% known or has produced a - P P T'das tification. as identification. 9� SfANIP STAMP Signature of Notary Public Signature of No 1Jek�s Print Name of Notary Public Print Name of Nol Pub is :;i+•!%: 2110 :.?' 4 MISSION#GG01116 MY COM EXPIRES March 22.2021 -1 ,�ee'►. Ie State of t\,otary Pubf of1Za r_ (Ices D G 09i44( *Revised;'l/16/24� Commission G .G -Y re 0712712021 .t PERMIT# ISSUE DATE. PLANNING & DEVELOPMENT SERVICES Building & Cade Compliance Division BUILDING:PERMIT SUB-CONTRACTOR AGREEMENT have agreed to be (Company NlarnefftidiViduJI Name) the - 2UMbk I A ik Sub-contractor for (Type of Trade) (Primary Contractor) For the project located at tj�0 S V J4_Jx 0u r am�.-_- f (Project Street Address or 4GpertiTak ID#} It 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. ._s .. ....... VTRACT0 GR B- AC O RE(Qua€€Fer)S " I f P NAME' i COUNTY CERTIFICATION UMBER COUNTY CERTIFICATION NUMBER, t�,� , State of Florida,County o _ State of Florida,County of MO{ t>, �} J jk The egoing ifis umem was signed before me this I y of The foregoing instrument was signed before me this o! day of who is personally known or has produced a _.., who is personally known___or has produced a as id tirication. s identification. i STAMP 't I ;;.t, _ STAMP Sig fire of Notary Public Signature of Notary 71lic Print Name of Notary Pubtle Print Name of Notary Public :#0 f�tary pudic state o9 Florir,-: SUSAN ances Dorua :.': Statcf`korida CorYrmission GG 0924«C .h. r orr nr-star`d Cc ,i�`; ' d}Cnn m Fzpiro Apr 13 Itevisad € 1rpires 0712712021 drlrPrcughHalou'. PERMIT# ISSUE DATE � � PLANNING & DEVELOPMENT SERVICES "i � Building & Code Compliance Division 1099M.- BUILDING PERMIT SUB-CONTRACTOR AGREEMENT St.Lucie County Contractor Certification Number: State of Florida Certification Number(If applicable): a nme. 4veemsE #05594 W C ®v have agreed to be the (Company Name/Individual Name) GA,-s Sub-contractor for (Type of Trade) (Primary Contractor) For the project located /J/0— (Project Sheet Add ss or P perty 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: J h( 00%jes : .a f1&C Address: W. City/State/Zip: L L . Phone: —472 -,2 Q ® 19 00 email: Rifte W* C®4v aA,b.&® �O SIGN RE PRINT NAME IT� STATE OF FLORIDA,COUNTY OF THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS_�L DAY OF 20,�J BY WHO IS PERSONALLY KNOWN OR HAS PRODUCED AS IDENTIFICATION. c. SIGNATURE OF N PRINT NAME NOTARY 0 ARY PUBLIC c ray,. •n•. . SLCPDS:08/06/2014 F r- P r � r°W Notary Publlti gim 81 pialdg h or `; Franceb bohN j My CWmIMM 6� �,Fod�' Exglra�ry`Jl�9l�@19 �