HomeMy WebLinkAboutSUBCONTRACTOR AGREEMENTPERMIT# I ISSUE DATE 1,
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if applicable):
(Type
For the project located at
Street
have agreed to be the
Sub -contractor for
�/� /� I (Primary Contractor) �f i
li%� rC. ice+ �% IQC Ct. �1 9��T
ddress or Property Tax ID 4)
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. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address:
City/State/Zip:
Phone: email:
SIGNATURE PRINT NAME
3-
DATE
,
STATE OF FLORIDA, COUNTY OF t
THE OREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY O 20 I_f
BY Ci( Q {� WHO LS PERSONALLY KNOWN OR HAS
ODUCED
S GN URE OF NOTAR PUBLIC
SLCPDS: 12/16/2013
IDENTIFICATION.
n
(STAMP)
PRINT NAME OF NOTA PUBLIC
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LASHAHNAINGRAM
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MYCOMMISSIONPEE 050558
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EXPIRES: December20. 2014
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Banded Thm Notary Public underwriters