HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
SCANNED
BY
BUILDING PERMIT StLucie County
SUB -CONTRACTOR SUMMARY
`C3 (��, using the following sub -contractors for the
(Company/Individual Name) II
project located at 1 m A� I
(Street address or Property�'ax 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
/
\\CSC
Plumbing
HVAC/
Mechanical
Roofing
-_-Gas—=
OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
a
Revised 07292014
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PERMIT# / /v , o a a� ISSUEIIA?E p
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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number of applicable): F_ C (3 o o 2 3 S
OCT 2 9 2015
Public Works
St. Lucie County, FL
SCANNED
BY
St. Lucie Counts'
trt c r1 C_ have agreed to be the
_ (Company NameAndividual Name) T
(eC,tr�caI Sub-contractorfor preCisic" &if SUS+QnIS T-ac-
(Type of Trade) (Primary Contractor)
For the project located at 3 i CO N. A i K
(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:
City/State/Zip:
Phone:
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Tan bs(er (6-2_R-IS
SIGNATURE - - PRINT NAME---- - — - — - DATE-- - -
THE FOP.GO`ING INSTRUMENTWASSIGNNED BEFORE ME THIS e�AY OF
BY J�\C�V' _ , ` WHO IS PERSONALLY KNOWN _
PRODUCED T L—� L 41 AS IDENTIFICATION.
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SLCPDS: 08/06/2014
PUBLIC
OR HAS
(STAMP)
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