HomeMy WebLinkAboutLot 30 DS Sub Contractor forms 9.13.2021PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
LLl will be using the following sub -contractors for the
4(Cpany ndividual Na e) rsA
_ \
project located at yae V u _ V �i!(J
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.
Trade
Name of Company/Contractor
St. Lucie County/
State of Florida
License Number
Electrical
Plumbing
boq W t1d
HVAC/
Mechanical
Roofing
Gas
a� 06
Comb
OFFICE USE ONLY:
PERMIT I ISSUE DATE:
NUMBER:
Revised 07/29/2014
PERMIT # ISSUE DATE
COUNTY`
F
L
O R
I D A
the
(Type of
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
it Name)
For the project located at 7 M `
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for�k'c1on\-)(
(Primary Contractor)
(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.
CONTRACTOR SIGNATURE uatlfier)
aoe
PRINT NAME
COUNTY CERTIFICATION N 'MBER
State of Florida, County of 'zi
T foregoing instrument was signedbefore me this 0 dsv of
. 20� , by
o is personally known _or has produced a
as identification.
STAMP
Signat re of Notan Pu c
l N e-s,Nuzl
Print Name of Notary Pu is
IL.--�
Notary Public State of Florida
Frances Donza
MyCommission GG 092440
Re% iced 11 16 2016Expires 07/27/2021
SUB-CONT R SIGNATURE (Qualifier)
a
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of3m��1
The foregoing instrument was signed before me this day of
]s ` 2021 , b,
who is personally known LC?or has produced a
as i fntifi tibWl ��on./
STAMP
Signature of tan Public
AUDREY MELLETTE
Print Name of Notary Notary u is ate of Florida
*= Commission # HH 52004
=7. My commission Expires
November 21, 2024
PERMIT# ISSUE DATE
COUNTY
F
L
D R 1
0 R
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
— (Company Name/In ' idual Name)�
the t LU-t 10 1 Sub -contractor i 3r
(T pe of Trade)
RECEIVED
APR 2 0 2017
BY: ..............................
have agreed to be
f Y � �c , u_ 1 yt-1c S
(Primary Contractor)
For the project located at
(Protect Street Address or Property T i X 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.
CONTRACTOR SIGNATURE (qualifier)
14
FFRINT NAME
G >B Aq 6951`
COUNTY CERTIFICATION NUMBER 4061—
State of Florida, County of �._
The regoing instrument was sign before me this day of
20Vby
o is personally known or has produced a
as identification. 0 1/�._ STAMP
Sighdture of Notary PubTicL
�J
r n f N o 1'
Notary�ubulic Wtate of Florida
Frances Donna
My commission GG 082440
E*m 0727r2021
Revised 11/16/2016
SUB -CONTRACTOR SIGNATURE (Qualifier)
1ppInC(k ►��19 C
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of "04 tYl
The foregoing instrument was signed before me this 1 day of
1 l 20t 1, by D"CA t Cl il--A LR�
who is personally kno)pff—Ior has produced a
as
of Notary Public
Printer Name of Notary Public
LAURIE URY
MY comki IS&ON # FF 210664
'•;o EXPIRES: July 16, 2019
Bonded Thru Notary Public Urdeiwnters
STAMP
PERMIT # ISSUE DATE
CUt.i
hJT
Y
F
L
O R I
D A-
J
the
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
ividual Name)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
For the project located at�
(Project Street
Sub -contractor for
or Property Tax ID #)
have ukreed to be
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.
ONTRACTOR SIGNATURE Qualir )
4
/J
P INT NAME�Gj�t/n/
COUNTY CERTIFICATIO MB
State f Florba
ida, County o
h oregoing instrument was sig before me t ' da of
20�\,Jby
w o is personally Mown Nor has produced a
as identifi •ation.
STAMP
Signaturt of Notary Public /
Print Name of Notary Publir
lay
NOarY Public State of Flonda
Frances Dona
r F►d� My Commiss'
Expires 07/2702 G 092440
Revised 11/16/2016'"
'% 1
Th regoing instru t was signe before me 7 day of
y /
w is personally known or has produced a
as
4_)"M5
rint Name of Notary
�O*PoeNotary Public State of Florida
Frances Donza
y+� My Commission GG 092440
'�1�NcF Expires07f27/2021
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
`I ��1DL6
(Project Street Address or
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.
� ��
CONTRACTOR SIGNATU (Qualifi )
&fio /
PRINT NAME
'!, V — lb -A 6g
COUNTY CERTIFICATION —NUMBER
State of Florida, County o
e foregoing instrument was sign before me thisc� da of
) 2Qby
w o is personally known or has produced a
as identification.
/lCT/" I .f STAMP
Signat ur of Notary Public
ens oiq
Print Name of Notary Public
v. !ut,�r�ry puphc; B;K:c ct i�ic IU;
� , F,�rartcaa t;r,;:taa
y
ttxp!tes d�I�Y�2o1� ya,�'+yTv
Revised 11/16/2016
J' _A44
S'UB- ON T CR SIGNATURE (Qualifier)
1��� f r,Jnla�
PRINT NAME
-1�(
COUNTY cERTIFICATIOE
State of Florida, County of
e foregoing instrument 1was sign before me thi ! y f
20�y
w is personally known _or has roduced a
as identification. n
it Name of Notary Public
R
Notary Gubbc St::,ia at Flonda
Frances Don2a
My Commission GG 092,140
Expires 07127/20? ;
STAMP
CGS
PERMIT # ISSUE DATE
_ PLANNING & DEVELOPMENT SERVICES
J = 1 _ Building & Code Compliance Division
•
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: 2
State of Florida Certification Number Qfapplicable): awE �,tcwsc_ #05594
(Company Name/Individual Name)
�_P — GA, S Sub -contractor for
(Type of Trade)
For the project located at
(Project Street Address or Property T x ID #)
Contractor)
have aarged to be the
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:
Address:
City/State/Zip:
Ld
Phone: ; XTI �SO email: L-sW �_a K a A il N& C�o�
SIGN RE P T NAME DATE
STATE OF FLORIDA, COUNTY OF Aylv�/,
THE FOREGOING INSTRU ENT WAS SIGNED BEFORE ME THIS DAY OF
BY WHO IS PERSONA Y KNOWN OR HAS
PRODUCED
SIGNATURE OF NOT
AS IDENTIFICATION.
PRINT NAME O TARY PUBLIC
R. c`1 Notary Public State or Florida
SLCPDS: 08/06/2014 Frances Donza
My Commission GG 092440
'1'orw� Expires07/27/2021
(STAMP)