HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENTERMIT #
RECEIk'7 ,;FEB 112016
ISSUE DATE
St.
State
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division SCANNED
BUILDING PERMIT BY
SUB -CONTRACTOR AGREEMENT at, ,L'ucle COW*
County Contractor Certification Number: �2 C;? V e
Florida Certification Number (if �pplicTble);
(Company Name/Ind
( ype of Trade)
For e project located at
It i
have agreed to be the
Sub -contractor for �P� /� L dJrV s f2 t - �
(Primary Contractor)
000
(Project Street Address or Property Tax ID
that, if there is any change of status regarding our participation with the above mentioned
I will immediately advise the Building and Zoning Department of St. Lucie County by filing a
of Sub -contractor notice. (Form: SLCCDV (No. 004-00)
QUALIFIER (Name of the Individual shown on the Contractor's License)
ARIZED SIGNATURES ARE REQUIRED
Name: QlT�mCE (S4 Z� /ice- n `a
;flip: C-` i� l ter
770 3 ?a -17 :2G email:
A� J= e f4l F_ LIA 1:3:� r—f 0� —/I — / 6
TURE PRINT NAME DA
kTE OF FLORIDA, COUNTY OF �--
E FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS / i%" DAY OF T eC l'vA OH , 20/6
✓ll->` 1 Vy46z� WHO IS PERSONALLY KNOWN OR HAS
TURE OF NOTARY PUBLIC
: 08/06/2014
AS IDENTIFICATION.
GREEN
Comm ssi ln# FF 112005
OF NOTARY PUBLIC =�: Expires August 11, 2018
fr BondedTkuTm/Fain lnuwmD00.385.7018
I
RECEIVr-:D Ff � 1216 RECEI',' D FEB ?fll6
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
BY
JQe Lude County BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
./`J�D C o�cJ,C✓%Lf���� & L will be using the following sub -contractors for the
(Company/Individual Name) �
project located at �100� eh/_/1J- /I sc Do?,
(Street address or Property Tax ID #)
It is understood that if there is any change 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
Z4C_
Plumbing
HVAC/
Mechanical
Roofing
Gas
IIPERMIT ISSUE DATE:
NUMBER: I I I II
Revised 07/29/2014