HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENTF fk"= D MAR 2
ISSUE DATE
...•... PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division SCAHm
- BUILDING PERMIT Bly
St. 1�1�D ®�� SUB -CONTRACTOR AGREEMENT
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St. Luci a County Contractor Certification Number:
II
State of Florida Certification Number (If applicable); rC 0003079,
Aceu iI E Lecuiml 906& MAWAI have agreed to be the
(Company Name/In�}'vidual Name)
Cac Sub -contractor for Me l -'Q .� i' d y Y, u C�1Uh
j (Type of Trade) (Primary Contractor)
For
It is
project located at 9 51 t - M3 6 - .0 < A 1- -do ® - 2
(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)
NOTARIZEU
Business Name:
Addres
City/S to/Zip:
Phone: i
SIGN'A URE
i
STATE OF 1
THE F REGC
BY kA .-e
II
PROD ,ICED
II
QUALIFIER (Name of the Individual shown on the Contractor's License)
SIGNATURES ARE REQUIRED
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email: bCM,91JC A77_t N67'
Aomp, 6%y & mg-&AI
PRINT NAME
COUNTY OF /zw,��-e
[iq i6
DATE
lG INSTRUMENT WAS SIGNED BEFORE ME THIS I_ DAY OF 20 / 4
ee�� WHO IS PERSONALLY KNOWN/ OR HAS
7;v,a�
AS IDENTIFICATION.
RE OF NOTARY PUBLIC P��AME OF NOTARY PUBLIC
08/06/2014
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