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HomeMy WebLinkAboutSUBCONTRACTOR AFFIDAVITPERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT S1yF1NEvJ M INTRACTOR AGREEMENT BY St. Lucie County ,--� `I �-A (� I e_ Gi V) C, have agreed to be (Company NameAndividual Name) the 9,l o O� Sub -contractor for AdangNotllaatNoNnreriHpldgtne (Type of Trade) (Primary Contractor) For the project located at Address or It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice. CO CTORSIGNA ua 1 er) Adnn9 HMO I4atONresttiorida, ma PRUITNAME COUNTY CERTIFICATION NUM State of Flarlds, Caanry� The fereaolat lmtn®ratwudjaed be6retee OB31 dgaT 20-6by William BryanAarnsl who Is peraonaay twowu!!LJ er hu produced e as Identifludan.— STAMP Sigaahrre of Notary FvhUe SHELLEYA SEPULVEDA Prtat Name ofNotary Pohlle +. SHEWILSEPII MA yy WCOMMISSIONOG0282074 i'r,'•. � E�IRE9:Janus1i25,202s '�. h.• geD)ad7luvNomry p44ApaNdtlattaa Revised 11/16Q016 FIRM SUB•CO"CrOR SIGNATURE (Quaa6er) 0)e-0V use_ R. C° rUi cksanlL PRINT NAME �aGr1g9 COUNTY CERTIFICATION NUMBER State of Rorlds, Coaary er 5C. W CA6 The forepola�iartrnareatwuripeed before are rhB 31 dayof MAkf .2011by Geca-ne R QCuicXShce'tt< who le penenally Ynom ✓or bus producedm _ _—'--_. as meatmntlou F i.•tvn..-rQ .�/Lo-YOIL9.o'r� STAMP Syoatare of Nohry Pabae 'PiCGY�r.[ Dcuc,les �ohvtm.-� Point Name orNotary Pall ^oawr roa:;, RICHARD DOUGIAS JOHNSON ,:;`�;o<, Notary Public -Stale ofFlonda Cemmissloed00004521 ?:I', ; MYComm. 6Pires Mar20, 2021 Borde4 Wc,gry NaibrW NaWy . PERMIT # =�:a� � � .A'i.:.... -..c_<='fit.?+ ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT the rtk/Y}G Sub -contractor for (Type of Trade) For the project located at Street Address or Property Tax SCANNED BY Lucre C®untv have agreed to be Adams Homes of No llmost Ffdtide, il1R (Primary Contractor) It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice. CONTRACTOR SIGNATURE (Qualifier) _Adams Hanes of Northwest Florida, by- PRINTNAME COUNTY CERTffICATION B Stale of Florida, County o; SA The foregoing instrument was signed before me this day of M204 J20lq by WilliarnBryanA ams � UgLlrt who is personally known _ar has produced a as ideo6fi eaff�� D STAMP Signature of Notary Public SHELLEYA. SEPULVEDA Print Name ofNote rl .......••. SHELLEYASEPULVEDA ` •` MY COMMISSION # GG 262074 'x•P EXPIRES: January 25,2023 Bonded Tbru Notary Public Underwriters Revised 11/162016 C19C©c�q' COUNTY CERTEFICATI N ZBER State of Florida, County of ST L CIQ The foregoing instrument was signed before me this _131 day of (1� 2019 by Lac r, y who is personally known Zor has produced a as identification. 9 STAMP Siature ofNotary Public LCIL:.rsRA !J G„A1as �A mInAs Print Name Name of Notary PNotary PO tic +.`�'1.0•_ RICHARD DOUGLAS JOHNSON Nalary Public - Stale of Florida CommissienlIGG0041321 "•�'oc F�'�'� My Comm. Expires Mar20,2021 BmCxCN'oyh NalbWNobry Ass. PERMIT # C,OUNTY��`, the ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division ,AM Trj (Company Narpe/Individual Name) (Type For the project located at BUILDING PERMIT SUB -CONTRACTOR AGREEMENT (Project Street ," SCtLJICC& _. 80A�- ",® By St. ZUC L4CO3 spy have agreed to YP61 Sub -contractor for MarroHotnesdNrxtMestFktlda,ttw (Primary Contractor) or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice. C ONTRAiCTOR SIGNATURE (Qualifier) Maas Homes of Naftest Florida. Ina. PRINT NAME COUNTY CERTIFICATION NUMBER Slate of Florida, Countyil The foregoiog instrument was signed before me this% .�L day of C' ,201cf by William Bryan Adams who is personally known _<r has produced a as identification. STAMP nature of Notary Public SHELLEYA. SEPUI VEDA Print Name of Notary Public ------------ u?'/.?�'••. SHELLEYA. SEPULVEDA •` MY COMMISSION # GG 262074 r}d EXPIRES: January 25,2023 • F9r h°��• flondedlhiu NaWyWMc Undeswnlels Revised I I/16R0 SUB -CO NT SIGNATURE (Quad fier) v.r S.-t�•.�� PRINT NAIVE aq c0,5 to COUNTY CERTIFICATION NUMBER Slate of Florida, County of Syk_�s,C The foregoing Instrument was signed before me this`5I day of Oq 20&by�2+I�ay 1Jn k3ieys1tv4£2. who is personally known ✓ or has produced a as identification. ��pp � CA1 /ICI'hmdxln-2 STAMP Signature of Notary Public t\er'V1jycl pcAA.gtnS l7ohv%sC/1 Print Name of Notary Phhlic RICHARD DOUGLAS JOHNSON •*�� Notary Pubric-Stateof Florida Commission #GG084821 My Comm. Expires Mar20,2021 . acre•.., amddlNagN NafW Noory0.5sn the PERMIT# I I ISSUE DATE (Type For the project located at PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT `5GANNED St. Luce County } kac ' have agreed to be Name) Sub -contractor for Adam limes atN%%wes FWkkttl- (Primary Contractor) WxWWG:l-cry '61 V d 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, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice. CONTRACTOR SIGNATURE (Qualifier) Adams Hades of Northwest RotMa, Inc PRINT NAME COUNTY CERTIFICATIO NUMBER n State of Florida. County �se The foregoing instrument was signed before me this 31 day of 20Ci, by William Bryan Adams who is personally known ✓ or has Produced a as identification. STAMP Signature of Notary Public �— SHELLEYA.SEPULVEDA Print Name of No •:*:%��•••. SHELLEYASEPULVEDA 's MY COMMISSION k GG 262074 ; ? EXPIRES: January25,2023 Bonded lhm Notary Puble UnderwrNers Revised 11:162016 SUB-CONTRAC'C0R SIGNAZURE (Qualifier)— _'. - S VVL'.t C. PRINT NAME COUNTY CERTIFICATION NUMBER State of Florida, County of '-Li-tclC The foregoing instrument was signed before me this _2L day of M��11_12019,by �fi GVs �, YF1GI OrtQ.� who is personally known ✓or has produced a as identification. "+5 ter'• b- tti'tsoL*— LI.OR'Ima t/ STAMP Signature of Notary Public ilieh0 "' l7rTavl4a t6hns0✓1 Print Name of Notary P Bc ;••'w: ar"y,•• BICHASD ON OUGLAS JOHNSO �'�. o c- - cn� : •= Notary Public - Stale of Florida CammissionliGG04821 °" tY �.'�~For.J�::' MyCorrm Erp'res Mar20.2021 Se Mltvogh Nd4orel NparyAssi