HomeMy WebLinkAboutSUBCONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
zz��
Building and Code Regulations Division
BUILDIN G PERMIT SCANNtL
SUB -CONTRACTOR SUMMARY BY
St. Lucie cot,,,
KIRCHMAN CONSTRUCTION CO. will be using the following sub -contractors for the
(Company/Individual Name)
project located at 10410 S. OCEAN DRIVE
address or Property Tax ED #)
It is understood that if there is any change of status regarding the participation of any of the sub -contractors
listed below, I will immediately advise the Building and Zoning Department of St Lucie County.
Trade
Name of Company/Contractor
St. Lucie County/
State of Florida
License Number
Electrical
H(Cfykc
C-CO() 0 1 OL/
Plumbing
N/A
HVAC/
N/A
Mechanical
Roofing
kho,
Gas
N/A
OFFICE USE ONLY:
PERMIT I I ISSUE DATE:
NUMBER:
Revised 07/2912014
PERMIT# I I ISSUE DATE I
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division SCANNED
BUILDING PERMIT BY
SUB -CONTRACTOR AGREEMENT St. Lucie County
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): !40000 la-7
have agreed to be the
(Company Name/Individual Name) KIRCHMAN CONSTRUCTION CO.
,2� & C,7�-,� 67r, Sub -contractor for
(Type of Trade) (Primary Contractor)
For the project located at 10410 S. OCEAN DRIVE JENSEN BEACH, FL ST. LUCIE COUNTY
(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
BusinessName:
Address: 3,;161 S�E l0,y#'e 14.,h
City/State/Zip: 6-foc�4 T-1- 310'37
Phone: -/3 9 S email:
1 LAJ kAL S
SJ�NA DATE
_�RE PRINT NAME
STATE OF FLORIDA, COUNTY OF P M-z7p rJ
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF 20
BY �XT>Lk) I LLt A-&k cz, WHO IS PERSONALLY KNOWN OR HAS
PRODUCED AS IDENTIFICATION.
1___\
OFNOTARY
SLCPDS: 08/06/2014
& Notary Public - State of Florida
Comm Expires Aug 2. 2017
COMMIssian # FF 38793
r P;-1- Notary Assn.
ARY
(STAW)
ANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division SCANNED
BY
BUILDING PERMIT St Lucie Counh?
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if pplimbl.): fte
11�c_ V-006ril 301(1410,7� 119,,:. have agreed to be the
(Corn any Namenhdividual Name)
00 _4z Sub -contractor for KIRCHMAN CONSTRUCTION CO.
(Type of Trade) (Primary Contractor)
For the project located at 10410 S. OCEAN DRIVE JENSEN BEACH, FL S I T. LUCIE COUNTY
(Project Street Address or Property Tu 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:
City/State/zip:
Phone: I
Ehtoi+ F7— 54114
email:
AIGNATURY PRINT NAME
DATE
STATE OF FLORIDA, COUNTY OF ad=�A 44� ;.t-
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS // DAY OF A!59�4 20 /,T�
BY 1/1� Au_ WHO IS PERSONALLY KNOWN _4---_6R HAS
PRODUCED
IDENTIFICATION.
REENIBUFFA
'-Mvo�mi
SIGNATURE OF NOAARY PIWIC PRINT Nj!!!,�
SLCPDS: 08/06/2014
(STAMP)