HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• Building and Code Regulations Division
RECEIVE[)
OL ANNED DEC 15
BY BUILDING PERMIT 2015
'3t Lucie CoUntPUB-CONTRACTORSUMMARY PERW1177ING
_M u nµ pp St. Lucie County, FL
e�tYfYY lLl'aV II 11�%I {t "r he using the following sub -contractors for the
(Company/Ihdividual Name)—
project located at 10600 South Ocean Drive, Jensen Beach 34957
(Street address or Property Tax 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
n
Plumbing
HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER: �y O�L�f
Revised 07292014
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICEIVED
Building & Code Compliance Divisio
BUILDING PERMIT DEC
SUB -CONTRACTOR AGREEMENT PEI
st. tgq!�C1eY�ounty St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): EQ 1 "-
_.Li��� _ r�L hl/ iui,� i . - _
,�., �. ,-
FI(co
Sub-contractor for kw
Vw of Trade) (PrimAry Contractor)
For the project located at 10600 South Ocean Drive, Jensen Beach 34957
(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: SLCCDY (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: WYE&_ 441Y1 I'I--_ c`I��(�
Phone: emailbuiQir) 0�Cr�1i1(71C7�
�ol�w►Ywn CY'(7 `� INI �S � ��
SIGNATU PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF �Pna IM Tg,\Ca
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME TBZS' c DAY OF I QjY1I `QK 20IS
BY C W1ri r� (` WHO IS PERSONALLY ENOWI— OR HAS
7-10710411s11
SI ATURE OF NOTARY PUBLIC
SLCPDS: 08/06/2014
AS IDENTIFICATION.