HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENT ELECTRICPERMIT# r I2�__ 04-S4 ISSUE DATE �rZ2_ 2O143
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): Fio-, % 3Q0 S3 9s
have agreed to be the
(Company Name/Individual Name) d
. Sub -contractor for &LLP INN of ,CTo ct
(Type of Trade) (Primary Contractor)
For the project located at
(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 filing a
Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name: (_-�ZGGlW 1✓A / 1l/L .
Address: _/ 4il SLa2CClv otY! tom/ /'
sv-
City/State/Zip: &C A's2 f e e eon L'l — I
Phone: (25a) .3VZ-92/3 email: !}r�hQd4.Ci00'��7
i QG L�8
SIGNATURE PRINT NAMES DA
STATE OF FLORIDA, COUNTY OF Cain
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS '9� DAY OF Jan C2l�t.�J , 20 "/9
BY Jp/C,e � ��t� �J WHO IS PERSONALLY KNOWN e/ OR HAS
PRODUCED AS IDENTIFICATION.
(STAMP)
?Ile 5� llo'
SIGNATURE OF ARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS: 08/06/2014 ,,�yp�� JOSE FRESNILLO
;a°, a`� Notary Public - State of Florida
o •_ Commission # FF 184850
My Comm. Expires Dec 22, 2018
Bonded through National Notary Assn.
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
nwice AQMUr�SD���Ir1C S have agreed to be
(Company Name/Individual Name) ; 4 V
the Sub -contractor for V
(Type of Trade) (Primary Contrac or)
For the project located aty —`Z V Wabrs Clml
r
(Project Street Address roperty 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 SIGNATURE (Qualifier)
RA
PRINT NAME
C(sc. ISrt sa43
COUNTY CERTIFICATION NUMBER a
State of Florida, County of �y►
The foregoing instrument was signed before me this, da/y�of
who is personally known or has produced a
as identification.
Signature of Notar3f Pub ►c
Ls,
Print Name of N tary Public
Revised 11/16/2016
Ir -Fr A2.A3aq _
COUNTY CERTIFICATION NUMBS
State of Florida, County of , ' u t ]� �%7
The foregoing instrument was signedbefore me thi/s'd6 �d/ayAof�
20 /7b ._ ()�
who is personally known yor has produced a
as identification.
STAMP l�'�`'� STAMP
1SIgIt.1%�lof �ary Publlice /(
Print Name of Nothry Public
p NANCY LEE LANGFORD
MY COMMISSION # G020372
EXPIRES: October 12, 2020
° NANCYLEELANGFORD
M� MMISSION # W20372
OF ntES: October 12. 2020