HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTPERMIT# T
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT SCANNED
v` SUB -CONTRACTOR AGREEMENT St. Lucie St. Lucie County Contractor Certification Number: C1e County
State of Florida Certification Number (If applicable): gC C)O oZ'al a
have agreed to be the
(Company Name/Individual Name)
/ Sub-contractorfor 1 G,.vn,p4on 04:;fi iJ
(Type of Trade) (Primary Contractor)
For the project located at qgs
or
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. (Force: SLCCDV (No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED J Business Name: Cyurr,pfc-, R1�-Es-ic.
Address: I aq P) n 1c] Cc,,,q rrS's /�� A-a-
City/State/Zip: I ,J-ej 'F- PG I w. V'xac�, C—t- 33u/C)y
Phone: _,Rol-say-(o.55c/ email:
JoO CfLol-447-70rJ S-Is-1
SIGNAT RE P NAME // DATE
STATE OF FLORIDA, COUNTY OF IIg] Aeclz 7
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS L2 DAY OF MiZeV t 20A
BY 1C k 0 C tMrn PMn WHO IS PERS2Nj KAiAWN OR HAS
PRODUCED AS IDENTIFICATION.
6 2 C4�� —
(STAMP)
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS: 08/06/2014 CHiUStt BARTOI)1CCI
ifb fiat MY COMMISSIONiFP 949866
EXPIRES: January 12, 2=
i,
Bonded Thru Nafary Pubic Underxriters