HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTPERMIT# ISSUE DATEl I
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number pfapplic ble): CA Q40 %
SCANNED
BY
St. Lucie Countl-
have agreed to be the
For the project located at 10999— 11 o3i 5 Oc�qzi, 451a- 333-G171-oco-�
(Project 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)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address: 1)�1 c) ,f) �r Ll 1 A L"S O \J 1- c
City/State/Zip: c 7 1 � W`t I >^y- 3 -i- ri ci
Phone: Cif a) �I $1— SI'�IgO e�email: ATP01 - L-GP f I W 01`t 1
NATORE PRINT N� DATE
STATE OF FLORIDA, COUNTY OF 01 /ld"Id
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS Z? DAY OF j:A4� 20Lr_
BY 17` I24 A/ .4AA KX & A/ i41 ___ WHO IS PERSONALLY KNOWN OR HAS
PRODUCED E-I d L R Q L69 %V �_% B N W AS IDENTIFICATION.
(STAMP)
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC " " LARRY POCINO
9SS3'Pfl MY COMMISsInN k FF067513
SLCPDS:08106/2014 ����,r EPIR[S:Dacnm+03,20iT