HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
SCANNED
BY
BUILDING PERMIT St. Lucie County
SUB -CONTRACTOR SUMMARY
rcG)- ezinn t%dfc k-wt, will be using the following sub -contractors for the
(�3umpany/Individual Name)
project located at
treet.athhess_or-Pro ec!1 �#)
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
` I t!.imn L /GC ' �. FC,
��.�- ��1d2✓l�,l�n-1
Plumbing
HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMTI f ' ISSUE DATE:
NUMBER: 1 �"l�
Revised 07/29/2014
uod (u-2 2-V0 0 "70
PERMIT# I / ST Q W/ /_ I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if applicable): G—00000
Sub -contractor for
(Primary Contractor)
For the project located at
(Projec Sfreet.Addross-or Property Tax ID #)
S BY ED
St. Lucie Cou*
agreed to be the
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
9"/-��
ME
STATE OF FLORIDA, COUNTY OF 7j[✓b1
THE FOREGOING `ILNS_T_RUMENT WAS SIGNED BEFORE ME THIS �_ DAY OF SoP$rnw) , 20�jr
BY _ Q S��✓a f L�Cs M P WHO IS PERSONALLY KNOWN OR HAS
PRODUCED AS IDENTIFICATION.
LIf� QOZZOLA
/627 - I C _ �/ J^,'p�,,°\/I " Commission R FF 110250
SING T1 ATUREOF OT UBLIC c PRINT NAME OF NOTARY PUBLIC ':,:P,.' My Commission Expires
Aptll 07, 2018
'SLCPDS: 12/16/2013