HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
SCANNED
RECE170 ""I qd2ob BUILDING PERMIT BY
. J�" � SUB_CONTRACTOR SUMMARY St. Lude Count%
Y—_ 10�,�zs 40y4j,�-k'OV%willbeusin g the following sub -contractors for the
(Company/Individual Name)
project located
address or Property Tax ID #)
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
Plumbing
HVAC/
Mechanical
Roofing
co%�ZA-r"CA"e.—
ccc�01108q
Gas
bFFICE USE bNKY-111
DATE:
IISSUE
I
Revised 07129/2014
06/28/2015 20:56 FAX 77246F"�" RK Davis R0001/0001
P��ALNNING & DEVELOPME NT SK '[CES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT SCANNED
St, Lucia Comity Contractor Certification Number. Co 2ra%g 04. BY
St. Lucie Countv
State of Florida Certification Number 01'applicabla): r. G C_ 0 % -3 0
have agreed to be the
sub-contraetorfbr.5�,.�%-.,-A
(Type of Trade) (Primary Contractor)
for the project located at
(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-conlractor notice. (Form: SLCCDV (No. 004-00)
9USME SS QUALIFIER (Name ofthe I . n ; iv'iclual shown 6 . n the Contractor's License)
NOTARIZED SIGNATURES ARE RE, QUIRED
Business Name: S&intnC6� S�)�Js
Address: 51.A % ac;,
City/StatetZip: V,�. IP " �_� &A 9 S q
Phone: 77-% - 14 e. V - 9F.?.:? (;' enudl: cJJ&%e15 Q_
's
'J. r.
SIONATU PRATINA�NM DATE
STATE OF FLORIDA, COUNTY OF ��L;
_7;�V
wonE m. Tms " / i1AY OF �r, 120��
THE FOREGOING INSTRUMENT wAs SIGNED BE ZZ
WHO IS PERSONALLY KNowN 11K.
OR HAS PRODUCED
AS,/#NTMCATqDN.
z (STAW)
E OF NOTARY PUBLIC PRINT NAME OF T 11C
V,
P IT
Ait
711TUR Notary'Plb11i'c- 1Rt111TJFI0dda*
16
MY Comm. Expires Nov 7. 2016
11 PE 217267
'.nlr-I Assn.
OFFICE USE ONLY.
PERMIT# ISSUE DATF