HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTPERMIT# I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES RECC-19!Ej)
Building & Code Compliance Division FEB 0 3 2016
BUILDING PERMIT SCANNEL-
SUB-CONTRACTOR AGREEMENT
St. LuCie County
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): ES Coon /-/0
t/2tTRrt41 S1Cnl Sub -contractor for
(Type of Trade) (Primary Contractor)
For the project located at
(Project Street Address or Property Tax ID
have 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
Business Name: i' E rr r �
r
Address: 9 U _ C
City/State/Zip: 11tJ f 4n f'/ _S.5 el 0 /
Phone: S'41 k10 z Y-2 tit email: a l�+,9 Y @ &AI&4 ,JI bV , Cp"
o R-A r lal) I& )Ll a /l r
NATURE PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF PA it et-. Z84C A
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS _Z DAY OF 20Z1g_
BY L NP r WHO IS PERSONALLY KNOWN � OR HAS
E PRODU AS IDENTIFICATION.
(STAMP)
A hU v
To PRINT NAME OF NOTARY PUBLIC ANDRIA M. SCHEELE
RE OF NOTARY PUBLIC :°. Notary Public - State of Florida
08/06/2014 5' + {; My Comm. Expires Feb 27, 2016
Commission # EE 166071
• • Bonded Through National Notary Assn.