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HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENT-T PERMIT# ~J �� ISSUE DATE f ra tire$' PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number. State of Florida Certification Number (Ifapplicablo l.r SOQ VAA QC&f , 9vN)A)01n : (Company Namellndividual Name) (Type of For the project located at 1 b have agreed to be the for C► m COA2" 04 d n u C (Primary Contractor) 3 oc ea n o.r. Lo Street Address or Property Tax ID #) S Alen Ci tctA �(.. 3q(gs7- 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. om-oo) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNATURES ARE REQUIRED Business Name: Address: C City1Stateaip Phone: email: C9J q 1 A PRINT NAME DATE STATE OF FLORIDA, COUNTY OF M(N THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF , UY-'e , 2 BY os,f I W) 0---es WHO IS PERSONALLY KNOWN _\�Ol AS IDENTIFICATION. W14 k co (Y-\ . (STAMP) OF NOTA Y PUBLIC PRINT NAME OF NOTARY PUBLIC +fy CWMNTERCORN y t r_ W COMMISSION # EE 852551 e0. EXPIRES: March 18, 2017 ` $tRf�NO Bonded Ttxu Notary Public Underwriters s 1LA PLANNING & DEVELOPMENT SERVICES DIVISION BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave Fort Pierce, FL 34982 MpLI ING PERMIT SUB -CONTRACTOR SUMMARY 1.Q"ill be using the following sub -contractors for the (Company/Individual Name) P_ project located at (Street address or Property Tax ID #) 3 --1 1S It is understood that if there is any change of status regarding the participation of any of the sub -contractors i listed below, I will immediately advise the Building and Zoning Department of St. Lucie County. Trade Name of Company/Contractor St. Lucie County/ State of Florida License Number Electrical S (0 4 Ge - I Plumbing �V Y Y �' � ` L� 1?z �5 HVAC/ Mechanical c IrYI Z 5 Roofing J l? .-Ta 10 2. ► -oU C.132.CjgQ Gas OFFICE -US-E ONLY: PERMIT I �r� ISSUE DATE: NUMBER: `f W PERMrr # 1 1 1 ISSUE DATE _ PLANNING &I DEVELOPMENT SERVICES Building & Code Compliance Division U401411 - BUILDING PERMIT ✓ DA SUB -CONTRACTOR AGREEMENT (� St: Lucie County Contractor Certification Number: State of Florida Certification Number (if applicable); ._ GI i 2Z have agreed to be the (Company Name/Individual Name) U� _ q-� C (� �, Sub -contractor for e M 1 1 C n &�%(_ (Type of Trade) (Primary Contractor) For the project located at `q* S 1 S Oca&D Or. Lb4' p'� cr"- so DCC__Jh J_ sT (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 wiffimmediately advise the Building and Zoning Department of St. Lucie County by filing a Change of Sub -contractor notice. (Form: iSLCCDV (No, 004-00) i BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNATURES ARE REQUIRED Business Name. felilli-e—TI�f1�lCLCI-T ..Lc.� 1e Address:___ fJ� Akry t.E -kL L 03 City/State/Zip; PGQ-i Si L,UL-y, '449 S(p.._�_:.__ 0NA : 112-1 alll- i LIC01 email: �llw 2tHer: _ �-hv c. `►g tma, ctwL TURE PRINT NAME DATE STATE OF FLORIDA, COUNTY OF THE FOREGO NG INSTRUMENT WAS SIGNED BEFORE ME THIS JL DAY OF 20�� By WHO IS PERSONALLY KNOWN OR HAS NOTARY PUBLIC - PLANNING AND DEVELOPMENT SERVICES DEPARTMENT • Building and Code Regulations Division BUILDING PERMIT SUB -CONTRACTOR SUMMARY GM Construction LLC will be using the following sub -contractors for the (Company/Individual Name)., project located at 10751 S. Ocean Dr. Lot B-8 Jensen Beach, FL 34957 (Street address or Property Tax ID #) It is understood that if there is any change i of status regarding the participation of any of the sub -contractors listed below, I will immediately advise the Building and Zoning Department of St. Lucie County. Trade , Name of Company/Contractor St. Lucie County/ State of Florida License Number Electrical Bellweather Electric 26164 Charlie Hopprnan EC13004122 Plumbing South Park Plumbing 27350 Jason Wintercorn CFC1426656 HVAC/ A/C Mann 22570 Mechanical Ted Mann Roofing Treasure Coast Roofing 19496 Brian Maloney RC29027087 Gas N/A OFFICE USE-0 NLY: PERMIT NUMBER: Revised 07/29/2014 ISSUE DATE: