HomeMy WebLinkAboutSUBCONTRACTOR SUMMARY-AGREEMENTPLANNING AND -DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
SCANONE-l"
BUILDING PERART Lu By D
SUB -CONTRACTOR SUMMARY St- Ck? Countv
etaL,>will be using the following sub-contractdrs for the
(Company/Individual Name)
_&ojiect located at (OLQ9' !�U55AKi.5�4�0, ;7-r. fterer,-, FL Sq�,sl.
(Street address or Prooerty 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
Plumbing
HVAC/
Mechanical
Roofing
Gas
(5c)605)vs 1 ISSUE DATE:
Pevised 07/29/2014
I
;J U .1b PLANNING & DEVELOPMENT SERVICES SCANNED
By
Building & Code Compliance Division St. Lucie COuntV
BUILDING PERMIT
_._._M._CON.-TRACTORA GREEMENT . ..... -
St. Lucie county contractor certification Number.
State ofFlorida Certification Number (if appowbi-x ECCnr)zzq,0
agreed to be the
for the project located at
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)
AUSINE SS QUALHUR (Name ofthe individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE, REQUIRED
Business Name: A-tyAw,:5.
Address:
city/Statelzip: CAT&A - tL 32,113
Pho OG(P- 37&&F email: 2S11 A'6Pw4C, #D_ A&,Com
PRINTNAIM FA-TE
STATE OF FLORIDA, COUNTY OF 1h Mdoj,�
TIM FOREGOING INSTRUMNT wAs SIGNED BEFORE ME TjHSLI5DAY OF 20 1 T
BY:R0?,1 WHO is PERSONALLY M40WN _X OR H&S PRODUCED
MMIRC IN
(STAW)
SIGNATUREJOF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
OFFICE USE ONLY:
Ic
Afty We - Swe of Swida:
WCOM ExOm Pay 3.,2oie
115751
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