HomeMy WebLinkAboutSub-Contractor AgreementPERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division n
-0
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT JUL
PEf1� ft!'•i'1iuC,,'
St. Luci,. Ceuntr FL
have agreed to be
pmZ7ny Name/Individual Name)the �//i Gj Sub -contractor for l /nelC,x)
(Type of Trade) (Primary Contractor)
For the project located at
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.
A ZZ-1- t k=s - -
CO RACTaR SIGNATURE (Qualifier)
hem &,2- l . �' A /?-/ x"'AJ
PRINT NAME
SUB-C NTRAC OR SIGN URE (Qualifier)
PRINT NAME
06y/ S-Dg1
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida, County of J State of Florida, County of J7 7
T e foregoing instrument was si ned before me this day of he foregoing instrument was sign e before me this Z 7day of
.'20
An
who is personally known r has produced a who is personally known has produced a
asi fife n. jas*ation.
STAMP STAMP
f Notary Pu '
Print Name of Notary Public
�otna;Puei��, SHERRiFErl MAN
My WMI ISSION # FF 1003770
� x EXPIRES: Match 1q, 2018
Revised 11/16/2016 N��rF oC=° Bart de dThruBudget�le�LarySerfiaes
Print Name of Notary Public
*WN42"V
E;(PIHES: 4i3fctt 1q 2n �g
)OFFLOR BondedThruBeai?t;�et�rv$zr•,,;,�
'.d XI�]� t_ OF.O- I DEAL®P1 NT
ERMff
•PERT-A!YTI IG
Si. Luc Co inty, FL
St Lucie County Cohtractor Cerfiflcation, Ndmber. 91'
State of Florida Cbrtificatlod Number (lt dppiicable):
has'.agreed to%be s'
(compdny#ndlvldiral riarng)Ot
' :• '' _ �: : s
the A';�: ':"','':::
sub�n$ ct%o '' or.' f �Ois
pype'ot cons
tnrction tin
,
(name of tw:prirne contractor)
for :the project located at
ropp tax lD,� It. IS .'Understood i➢��
(sheet addres9- or p,
if #here is and chartg19 of stetua regarding bur �arficipatiort. �vitto the above Mentioned
project, I will Immediately advise - the Cominulji#ji:I:®eveloprhent Depadmant (Growth
Management:bivisloh)::of St. I!.ucit',County.by;persgrlall :'fling:a Cliartge of Contractor
Form.(SLCCDV FORM N:O: 004-00),
i3USIN
t UA (odglnal slgidturei teyuired):
r
a�
sibnatu print name ' . date '
buslness na e:
address:,C. .dc IS AIf :
city,state,zlp: Via:. .� . �. cis I L ::�'
phone: ' ' • Z M 7 -
ri SLCCDV FORM NO.: 002-W
PERMrr # : ISSUE DINE 1.1I