HomeMy WebLinkAbout5800245_St. Lucie County_Sub_AppDacuSign Envelope lD: DF4463A6-89A7-40B4-B9C8-Et0'f1F534DAA
�µo -IE�I� Sapp 24�
Ericsson, Incl Frank Kisel
the
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name)
Electrical Sub -contractor for Ericsson, Inc/ Steve Nichols
(Type of Trade)
For the project located at
(Primary Contractor)
5041 ST. LUCIE BLVD FT. PIERCE, FL. 34996
(Project Street Address or Property 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.
CONT T GNATURE (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this Zr7 day of
A?�' � 20-a b� S Je re wl'+cam 1 c
who is personally known �or has produced a
a
endfication.
i nature of Notary Public
Print Name Floe
oFN h+'Ys'-' T '
a�fw w� Notary Public State aF
r r : Angel Rwer3
y 4 hAy Comm+scion CyG 12t794
y� p expires 9 W24120a�
Revised 11/16/2016
E Do
cuSigned by:
-o1
29Ai]273AB861481...
SUBCONTRACTOR SIGNATURE (Qualifier)
Frank Kisel
PRINT NAME
32300
COUNTY CERTIFICATION NUMBER
State of Florida, County of Seminole
The foregoing instrument was signed before me this
April , 20__� by Frank Kisel
who is personally known X or has produced a _
as identification. ooauSigned by:
STAMP
Signature of Notarypub
"'
Evan Wong
Print Name of Notary Public
EVAN DAVID WONG
Notary Public -State of Florida
Commission # GG 350394
Commission Expires 7/1/2023
19 day of
STAMP