HomeMy WebLinkAboutChange Of Contractor Or Sub-ContractorMay '14 15 02:16p Wallen Service Corp.
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May 14 15 02;17p Wallen Service Corp., _
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561 689 9393 p.3
PERMIT# l3 f� Q - ? ISSUE DATE
PLANNING & DJEVELOPNNNT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if applicable):
Z'�R- G ew ( ICI e y � have agreed to be the
(Company NaryiIndividual Name)
Cr4 Sub -contractor for a
(Type of Tr e) (Primary Co tor)
For the project located at P,)3 ;:L- -T,
(Project Street Add
or Property Tax ID #)
It is understoodthat, if there is any change of status regarding our participation with the above mentioned
project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a
Change of Sub -contractor notice. (Form: SLCCD'V (No. 004-00)
BUSIENESS IQUALMER CName-ofthe Individual shown an the Contractor's Liceuse)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address:
City/State/zip:
Phone:
email:
to, ;44
L4 A [mild 62 - �
SIG ATURE .P T NAME DA
ST OF FLORiDA, COi)i�TX OF
THE FOREGOING VgSTRUMENT WAS SIGNED BEFORE ME MES _a_ DAY OF /2D��
BY 1441Z !_ GU 19 i l j JJ i&- WHO IS PERSONALLY IMOR^V t/OR HAS
PROD ED
SIG ATURE XCOTAORYPUBLIC
SLCPDS:1Z11G/i013
AS IDENTIFICATION.
C^ (STAMP)
P T NAME OF NOTARY PUBLIC 7 WffAM
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