HomeMy WebLinkAboutSUBCONTRACTOR AGREEMENTSPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
i BUILDING PERMIT
r SUB -CONTRACTOR AGREEMENT
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St. Lucie County Contractor Certification Number: p �o / VC�� C00
nty
State of Florida Certification Number (ifapptimbte):
Gw va have agreed to be the
Name/Individual Name)
vim. f \ sub -contractor for
(Type of Trad )
tz�, C_.) A S-A-) PaC=1c,S -
(Primary Contractor)
for the project located at �? [14-h •T� �r: � A-/i f 71Cei
(Project Street Address or Property Tax ID #) -
It is understood that, if there is any:dhange of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGIN IG ' TU S ARE REQUIRED
".
�o� .I! �2u-tt'\\
� - 3c>
NATURE PRINT NAME / DATE
Business Name: 1,,-,
Address:
City/State/Zip:
Phone:
OFFICE USE ONLY:
email:
PERMIT # ISSUE DATE
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- I
.. STi L C E
DEPARTMENT OF eOMA
9MLDINC;
SL Lucie County Cohhactor Ceriifl} anon: Number.
State of Ploridd Certtflcatton Number (It dppueable): _j
(eompenyApolvktual name)
the E�. €C� c i cn_ ,� sub contractor.
(type of eonsWdton trade) ..
fT
for the project located at. /ZbL /,�A7-��- LA-3 ;
(street address or property tax ID p
if there is any change of status regarding our patticipal
Project, I will immediately advise the Community Deve
Management.t)ivlsion) of St. Lucie County by personally
Form (SLCCDV FORM NO. 06"p).
M,
business nab:
address:
city,state,zip:
phone:
PERMIT p
DEVELOPMENT
AGREEAMNd'
i
SCAIYIVED
�y 'St: Luce County
u% has;agreed to be
(name of the:pdmaeonlrador) .
If Is understood that,
1 with the above mentioned
orient Department (Growth
ng A Change :bf Contractor
i
(orbinatslgnr;ture! required):
print name..
i .
PA Vu ES
2 S"d f .A L: trt S A , Y�
vim- z- 7
date
I.
SLCCDV FORM NO.: 002.00
ISSUE DATE
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