HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENT,r
PERMIT# Y_, D Z ISSUE DATE
PLANNING &f DEVELOPMENT SERVICES
Building,& Code Compliance Division-j6AWNW
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BUILDING PERMITQ
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number. Z % -7 5-
State of Florida Certification Number (if applicable):
am r have agreed to be the
(Company Name/IndividI Name)
e_ ,, f'G 7 Sub -contractor for
(Type of Trade) (Primary Contractor)
i
For the project located at SoZ Ae_27 5�
(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: /// /Q/�?+ �� «�����'�C2��2,% —�- �� e_
Address:��.�
City/State/Zip:
Phone: `772—email: ez z,
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SIGNATURE PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS \� DAY OF N t V , 20 \ 1
BY 'ir Ck-N \f\ k \-Z) Ra lAk i s cbl WHO IS PERSONALLY KNOWN OR HAS
PRODUCED 'V L AS IDENTIFICATION.
SIGNATURE OF N&FARY PUBLIC
SLCPDS: 12/16/2013
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PRINT NAME OF NOTARY
Notary ruun. - ----
My Comm. Expires Dec 46, 201
Commission National Notary As,
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