HomeMy WebLinkAboutSub form, 2110-0772 Sub Electric Permit appPERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
` - = Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Ericsson, Inc/Frank Kisel
(Company Name/Individual Name)
the Electrical
(Type of Trade)
For the project located at
Sub -contractor for Ericsson, Inc
3111-122-0015-000-3
(Primary Contractor)
(Project Street Address or Property Tax ID #)
have agreed 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.
CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this day of
, 20_, by
who is personally known _or has produced a
as identification.
Signature of Notary Public
Print Name of Notary Public
Revised 11/16/2016
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SUB -CONTRACTOR SIGNATURE (Qualifier)
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PRINT NAME
COUNTY CERnT�I�F��ICATION NUMBER
State of-Fhrridzr, County of _LL�Z-
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The foregoing instrument was signed before me this X day of
0C�VJ-e-� , 20,,A, by L i5e-,
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who is personally known _or has produced a .P Coyk'k. Z)'1V��
as ident' catio
STAMP
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Print Name of otary Public
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