HomeMy WebLinkAboutATC 5080 Dish MIMIA00246A contractor verification form signedPERMIT # 2110-0012 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
•
- Building & Code Compliance Division
-- BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
ATC 5080 Dish MIMIA00246A Collocation
CEI North Inc.
have agreed to be
(Company Name/Individual Name)
the Electrical Sub -contractor for Carrrick Contracting Corp
(Type of Trade) (Primary Contractor)
For the project located at 1480 Dyer Rd, Port St. Lucie, FL 34952
(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 -contract notice.
CONTRA SIGNATU (Qualifier)
Thomas James Carrick
PRINT NAME
CGC055115
COUNTY CERTIFICATION NUMBER
State of Florida, County of —Raw QC k
The foregoing instrument was signed before me this 10 day of
, 20 Z Z'by O MCA j � • CO rr � G 'L_
who is personally known ✓or has produced a
as identification.
STAMP
�gn tore o tary Public Print Na
°�e' JACLYNN E. MCNEVIN
Notary Public - State of Florida
9 Commission .," GG 976356
?F rs;" ` My Comm. Expires Jul 30, 2024
Bonded through National Notary Assn,
Revised 11/16/2016
SUB -CONTRACTOR SIGNATURE (Qualifier)
David A. Birth
PRINT NAME
EC13001924
COUNTY CERTIFICATION NUMBER(
State of Florida, County of ,rn 1J<.G C�1
The
`foregoing
-instrument was signedd before Me this �day of
20by, sJIJ�� 1 V f' Cl l
who is personally known _or has produced a
as identification.
YSTAMP
ignatur of Notary Public
Print Name of Notary Public
Notary Public State of Florida
Alyssa McGee
My Commission
111i HH 194814
EXp.11/15/2025