HomeMy WebLinkAboutSub-Contractor AgreementA.
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
- — BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: 21055
State of Florida Certification Number (If applicable): EC0002938
ELECTRIC CONNECTION/RANDY SJAARDEMA
have agreed to be the
(Company Name/Individual Name)
ELECTRICAL Sub -contractor for Fountain Blue Pool Service Inc.
(Type of Trade)
For the project located at 3010 NW Radcliffe Way
(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, I will immediately advise the Building and Zoning Department of S tic, County by filing a
Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00)
BUSINESS QUALIFIER (Name of the Individua n o contractor's License)
NOTARIZED SIGNATURES ARE
. — REQUIRED
Business Name: L l eCTY \ G l , %n h k—G-,V--1 r-Wn
Address:
City/State/Zip:
Phone:
1100 BARNETT DR # 4 i -
LAKE WORTH, FL 33461
561-586-6499
email: SITYANB@ELECTRICCONNECTION.NET
RANDY SJAARDEMA 11/30/17
SIGNATURE PRINT NAME
STATE OF FLORIDA, COUNTY OF ST L U C I E
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS 30
DATE
DAY OF NOVEMBER ,2017
BY RANDY SJAARDEMA WHO IS PERSONALLY KNOWN X OR HAS
PRODUCED P/K
SIGNATURE OF NOTARY PUBLIC
SLCPDS: 08/06/2014
AS IDENTIFICATION.
SITYAN T BROMELOW
(STAMP)
PRINT NAME OF NOTARY PUBLIC
Pool,'SIIYAN
N. 0 7t 4?
I BROMELOW
Notary Public - State of Florida
Niy Commission Expires Oct
•
17, 201B
Commission # FF 147106
Bonded By National Notary Assn. `
-vti-fir .
the
M �
A
PERMIT ISSUE DATE
(Type of
For the project located at
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Sub -contractor for
. - I I. .
Street Address or Property, Tax ID
have d to be
in
UA.) Lo 0 Is
atractor)
� I
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
Hung of a Change of Sub -contractor notice.
4�7
CONTRACTOR SIGNATURE (Vm'r)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State offlorida, County of
J2.
The foregoing instrument was signed before me this __L4:f day of
20 f 7by
�'NL%N "O-psvy 1/10'�
who is personallyo has:prbducpd it
as idend 60M
7-7.1 —0
A7!&
ignature of
la
'IN
Revised 111W2016
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of rT
The foregoing instrument was signed before me this 113 �Ryl of
,Pk 2o-L7by - QW4 L.;;J
W
who Is personally Im' . a I
Ord ced
asidentification/ '4
;Ignatuke of
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ed vele..
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Print Name of Notal fo; ......