HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTPERMIT # 5o a - o a55 ISSUE DATE
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PLANNING & DEVELOPMENT SERVICES `;0
Building & Code Compliance Division e1.91
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BUILDING PERMIT es
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if applicable): �B l
(Company Namellndividtbl Name)
` (Type of Trade)
For the project located at
have agreed to be the
ab ntractor for>���
(Primary Contractor)
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, 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) SCANNED
BY
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) tit. Lude C'OUio
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address:
City/State/Zip:
Phone: 7
kGNa'kkte,s aArL-t� a.��-�SATURE PRINT NAM DATE
STATE OF FLORIDA, COUNTY OF
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF 20/K-�
BY WHO IS OR HAS
PRO UCED AS IDENTIFICATION.
(� (STAMP)
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
y1 W Notary Pudto state of Fiord
SLCPDS: 08/06/2014 f 1j . Tracie L Lamb
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