HomeMy WebLinkAbout#2103-0657 Electrical Sub-AffidavitPERMIT# S& oLl03.Q(io57 ISSUE DATE 6//t/J,I
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Name/Individual Name)
the Electrical
(Type of Trade)
For the project located at
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub-contl'actor for Thompson's Remodeling &Home Repair, Inc,
�0
(Project Street Address m• Property Tax
(Primary Contractor)
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
fil ing of a Change of Sub-conU•actor notice.
CONTRACTOR SIGNA fier)
I C.,ri
RIN
COUNTY CERTIPICAT'ION NUMBER
State of Fl01 (la, Counhof Indian River
The foregoing instrument was signed before are this day of
ao , by Ronald Saxonmeyer
\rho is pelsollally T(nomll t� of has produced a
as identification.
STAMP
S'gnahre ofl ry Public
P
"`'`Oe;; RAVINAMICHF.LLE OARIiLEY
Commission II GG 17M109A
Expires February 3,2022
Bonded Thm Troy Fain Insurance 300-3y\ 5-7019
Revised 11/I6/2016
SUB -CONTRACTOR SI.9IQATURB'(Qualifier)
Luh4ld rAunhvnt ��
PRINT NAME
363 R4
COUNTY CERTIFICATION NUMBER �f
state of Florida, County of� ez �`,u^
Theforegoing instrument was signed before me this
�inday of
mho is PeKonally known v or has Produced a
a 5`1 dell
lttif ea fion.
Y 1 elz&c� STAMP
Sigriathre of Notaiy 1761ic
Print Name of Notary Public
� '"r'�� RAVINA MICFIELLE BARKLEY
Commission N GG'174094
Expires February3,2022
.:9F `O•` Bonded Thru Tray Pain Insurance 90039r7019