HomeMy WebLinkAboutSub-Contractor AgreementUY
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'�AGREEMENT '
-;Odgr:
St! Lucie County Coh6ctor Certification; Number.
State of Hoddd Certificatioti hutnber (11 �ppltcable):
has -:agreed to••be
(compdnyAndlirtdU�i riarxr®) I : : r
the I':1: /
sub�n$octtiP:'
(typ®'oG construction (trade) :.(Hama oY th®$rimd•contractor)
i.
for the project located at
street address or ro lax tCl #) lt• is UnderstOOd that,
h peity
if there is and charig1 of status regarding our patficipati®ire. with the above Mentioned
project, I will immediately advise, the Commtlrji�i::®eve oprrten@ ®apartment (Growth
Man agament: bivisloh'Y of :St. Lucio Coupty. b rsor➢all �litu a Chahgd-'bf Contractor
J.
For(SLCCDV FORD NO: •004-00).
SIN
SU
QUA (orlglnal sigrodturet required):
signafit print namb ' : j . date '
business na e: •�
Y 1"-�
address: :.'�•"CS
city,state,zip:.t.
phone: ! • �: :. .. ! : I : i
f ; I SLCCDkl FORM No;: O02-00
PERMrr # ISSUE t)ArE I
l .i
r
PERMIT # ISSUE DATE
---- PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(C m ny Name/Individual Name) D /
the /199Gj Sub -contractor for
(Type of Trade) (Primary Contractor)
For the project located at
5 DO G 1
1 + M
(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 -contractor notice.
CONTRACTOR NATUR (Qualifier)
1 "6 _�- A "/-, /"J.
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of� Czp—,
Thee foregoing instrumerrnt was signed before me this day of/ \
�L ,29?b�I�ed�
who is personally know has produced a
si
de ica 'on.
STAMP
o Notary P is
Print Name of Notary Public
t,GV pu SFiEw-u ri-IM AR
�%
/ MY COMMISSION 3 FF 100370
1, � *0':
EXPIRES: March 14,2018
Revised 11/16/WoBendedThruBudgetWaryServices
SUB -CONTRACTOR SIGNATURE (Qualifier)
4-18 �/_ , � A��Z"l A�9�
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed b�aefore me this ay of
]
who is personally known r has produced a
as id tion.
STAMP
Sig . ture of Notar . u .c
Print Name of Notary Public
�,`vPu SHrRRlFEHLPh�N
* * MY COMMISSION S FF 100370
EXPIRES: March 14, 2018
�r4lE�F�pP��� BondedThruBudgetNotaryServices