HomeMy WebLinkAboutSubcontractor Agreement W Y r N PLANNING & DEVELOPMENT SERVICES DIVISION
BUILDING&CODE.REGULATIONS DIVISION
2300 Virginia Ave
- — Fort Pierce,FL 34982
BUILDING PERMIT
SUB-CONTRACTOR SUMMARY
will be using the following sub-contractors for the
(Company/Individuuall/Name)
project located at , C�(,� QZ� ) Q
(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 �1,3[S® /2-7
Plumbing u 6 � ��G �S_ 6
4i , /
HVAC/
Mechanical
Roofing
Gas
OFFICE USEONLX
PERMIT ISSUE DATE:
NUMBER:
r
--'btP TImNT OYOl-➢, r.E
DEVEL®.P`i NT>�LDII N4
St Lucie CountyCohtracior Cer0fication'Ndmber
State of Florida CerEiflcatioti @dumb°er(It ipplicab{ey: m 1! �� ` Z 7
has::agre6d to'-be
;(compdny/In6kf i@ name) I;
ttte �L.•�.�'`���•c�:�� ; , ' "stib�ti�f�ictor:' or.��' Z
(type'of wnstnfdion trade} ' •:-6 ma of Iii4rifftd•contractor) t
for the project located at r '9t is understood that,
(streetpaddr1esd•or prope,*tax lD•#) `
i
if there is any chaligo of status regarding our participati®rt. ltvith the above Mentioned
project, i will immediately advise, the ComtmOolty:i'Devoloprhent Depaitmant (Growth r
Ma agement:bivlsiorij :of 9t. Lucio:County.by:„ptrrsonaili '' I Ing:a Change<t�.f Contractor
Forth SLCCDV FORM IdO:•004-oo). :
SUS IN (QUA •(originhisloridture9 tequired):
: si natu :. print name date '
business na e:
address: AL : IS Al i' ,i ,
city,state,zip: .'t'
phone:
SLCCDV FORM NO.-.002-M
PERMIT 0 ISSUE DATE 1
I
r^
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
BUILDING PERMIT
o . SUB-CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: O L '
State of Florida Certification Number(If applicable):
have agreed to be the
(Company Name/Individual Name)
sub-contractor for G
of Trade '
/_'_'gY(_Type ) (Primary Contractor)
for the project located at
(Project Street ddress 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 personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER - (Name of the Individual shown on the Contractor's.License)
ORIGINAL SIGNATURES ARE REQUIRED
<9e)g
f4SGNA RE PRINT NAME DATE
Business Name: ;�'
dd /�
Address: 3 0
City/State/Zip: fiT ere-
Phone: o S - Q _ email:
OFFICE USE ONLY:
PERMIT# ISSUE DATE