HomeMy WebLinkAboutSub-Contractor AgreementPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
1BUM1D1M PEItMff
SUB-CONIMCTOR AGRFEEM NIr
St. Lucie County Contractor Certification Number: (_
State of I:la dda Carti wdoe Nnmbec afwuc"): EC 000 3072 '
AcuuAtTE F, much( (ouMnJroJ, Ilue— have agreed to be the
(Co npW Na=cftdWdual Name)
sub -contractor for M91— V rf - to'
('I`ype of TM&) (Primary ontr$ator)
for the project located at ,� 0 7®. f S C; �`� �'G t�r� . 3� t2 4 t7 :7
(Project Street Address or Pmpwty Tax ID #)
It is Understood that, ifthem is any change o£statm regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. OFurm: U=Dv
No. W4-"
BUSINESS QUALIFIER (Name of $e bdm& W shown on she Caauacovr'a Liomse)
ORI AI. SIGNA ARE REQUIRED
Akrigue, E J1XLMA,Ni
SI TURE PRIM' NAM DAZE
A4XV 1� 4ELTk IC4 Cawrg&fW4 nu C
,A,adtem- 730o GA10 A.
C%wSftftrw- #A. r S-r Lve tf FL 3 5sZ
Phoae: 7 ► email: be1rF MC Alf, ar
OFFICE USE ONLY:
= { ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: I %[ p( y
State of Florida Certification Number (If applicable): 1� V� & 0
Cf have agreed to be the
(Company Name/Individual N q e)
' v
_ sub -contractor for
(Type of Tr I
e) (Primary Contractor
for the project located at/& �� l S CJ �� rC & 3 7 `7J
(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, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGINAL IGNATURES ARE REQUIRED
SI W PRINT NAME DATE
Business Name:
Address:
C_
City/State/Zip: �Cl'Lk �� . t A ( 3 4 S S7
Phone: email: �C h1�C� l 1l�iC,dirv�ellSl 0�5 Gost1
OFFICE USE ONLY:
PLANNING & DEVELOPMENT FVICES
Building & Code Compliance ' -Anion
a
• �DAYG I'EIiMTr .
SUS -CONTRACTOR AGREEMNT
St. Lucie County Coatcactor Certification Number,
State of Florida. Certif 460n
sub -contractor for
for the project located at
bare agreed to be the
S'�`Fi2(�e�vK
(Yt'0j0� Street Address or I -rap � ® #) � - *i 7
- — — G7
It is understood that, if there Lf SI)
is any Chang o� regarding our artici 'on with the abo e e "
- _ _-- —_. ---- -. - _ g _. . � __-.._ .__ -v _m_aoned___ _ _...
project, I will immediately advise the building and Zoning Department of St. Lucie County by filing a.
Change of Submcontract0* motiC0" (Porm: SLCCnv (No. 004-U0)
•l`^`` j
a' US vEss QUALIER (Name ofthc IudividW Aovm on the Contractor's License)
NOTARIZED SIGNATURES AIRE REQY3.IRED
Business Xwne:
Address;
_ • �h a �
Phone: I. Ill Ic'm 'rl W rAmI6
b, +
f
ADWRANE s
STATE OF FLORMA, COUNIT I?F c
THE FOItEGOIlYG INSTRUMENTi�5 3TGN D DEFoRE M TMS _2- . DAY Off' ItA�IJ�ti�i� • . 2ri I rJ
D'Y T kA J � �.L AVOL IS PERSONALLY KNOWN � OR RAS PROAUCED
AS i TIPICATION _ (STAW ):
�� IdhS
SIG OF' NOT 'Y I' C
PIUINTNAM OF NOTARY -P • LIC
OFFICE Z
PLANNING & DEVELOPM N T SERVICES DEPARTMENT
r ; BUILDING & CODE ]REGULATIONS DIVISION
BUILDING PEST
SUWCONTRAC'rOR AGENT
St. Lucic County Contracwr Certification, Number.
State of Flcrida Certifitc sAon Nwnber (if appli-bla): /IT-= q
y'v5 ��Psrz'-c 'have agreed to be the
(Company Nautcan dividttai Name) f
sub -contractor for
(we Of �). (Primacy Contraaior)
project located at � 7 s w 7 Lz
forthe pry) Tax ID #)
(Project Street Address or ftoperty
it is understood that, if there is' atty 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 personally filing a Change of Contractor u0tice. (Form' sLCcl)v
136. 004-00)
$Y1SMSS QUAI:IFI R (Name of the Individast shown onthe ContracWr's License)
DATE
wrrr7r/Y'M� rTCVW.7 t1ltTY 'cr_