HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTPERMIT # ISSUE DATE
COUNTY.
F L O R I D A
PLANNING & DEVELOPMENT SERVICES
Building.& Code Complianee Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): FS d O e, e9 i Y1Z
gT
Con*
have agreed to be the
(Company Name/Individual Name)
.Ele r— 7`2 r e Q l Sub -contractor for
(Type of Trade) (Primary Contractor).
For the project located at
(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 QUALIII'IER (Name of the Individual shown on the Contractor's License)
NOTARIZED.SIGNATURES ARE REQUIRED
Business Name:
Address:
City/State/Zip:
9YS' z6� rA� sr
Phone: ;�(0 k'� L y 2 Y Z email:
ISIGNATURE PRRI T AME DATE
STATE OF FLORIDA, COUNTY OF I Ja1 n+� P o c .k �—
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS 13 DAY OF 'ICA a 20 14
BY � h `� L , �_1 6 WHO IS PERSONALLY KNOWN _�� OR HAS
PRODUCE AS IDENTIFICATION.
/ �/�//,� �/ J ( : iiw'r'n"�e,, �•AI�Dr/f (v{. SCHEELE
Notary PubliC - State of Florida
SIGNATU .OF'NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC ; My Comm. Expires Feb 27, 2016
Commission # EE 166071
SLCPDS: 08/06/2014 " ° °`O Bonded Throuah National WPM Aesn