HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
SCANNED
St. Luc8Y
BUILDING PERMIT COutyy
SUB -CONTRACTOR SUMMARY
will be using the following sub -contractors for the
(.0 dividuslName)
project located at
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
S" 1
/ r 3 a 0
Plumbing
HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMIT I ISSUE DATE:
NUMBER:
Revised 07292014
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable):
«sfC-camaany Name/Individual Name)
f ' Sub -contractor for
Pe: (Primary Contractor)
SCANNED
St Duce County
have agreed to be the
For the project located at /a37j l Gr�--c x l
,($riai,(> rim �tr�etvt ddress onEroperty T.a 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: SLCCD V (No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address: ! 92 i Y
City/State/Zip: /04�
Phone: email: 4a t . ca.
P t�C /�N�°A/-Jry/��E
STATE OF FLORIDA, COUNTY OF A44-%�/ I
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS 10 DAY Ot�, . ,
BY P_ / D AJ M EQ WHO IS PERSONALLY KNOWN OR HAS
PRODUCED C AS IDENTIFICATION.
i
SIGNATUR F NOTARY PUBLIC PRINT NAME OF N TARY PUBLIC J-
SLCPDS: 08/06/2014
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RwrJed P.rm RbYdOyN#FF�EXPIRES: Ma
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICF
` COUNTY Buff &Code Compliance Division
-- BUILDING PERMIT sf4 2016
SUB-COIT'�ATO�RQAGREEMENT St. LUC' ' I,
St. Lucie County Contractor Certification Number: II ''BOO[[ St• uc�e ouu Y FL
State of Florida Certification Number (If applicable):
have agreed to be the
�`/� (Comp y Name/�Ind``i'' ' ual Name)
XZ X z 1—P Sub -contractor for
(Type of Trade (Primary Contractor)
For the project located at { d 3 3/ d U r l 3
(Project Street Address -or Prope #) _
Ad
It is understoo that, if re is'any c u e o�status r_ ar mMartr'cip�tron 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:
Phone:
��i/��
f� (A-Z �
HAV1m ?CX15Cv'
PRINT NAME
STATE OF FLORIDA, COUNTY OF L Y l Q /jam ak6
@ 0,,V
0
THE FOREGOING INSTRUME WASSISI
/GN
� ED BEFORE ME THI DAY OF -
BY I �� I Qir� ► IU� WHO IS PERSONALLY KNOWN OR HAS
PRODUCED r\ AS IDENTIFICATION.
r (STAMP)
OF NOWY PUBLIC/PRINT N E OF NOTARY PUBLIC
SLCPDS: 08/06/2014
"v'o"•. MISTY LUNDEEN
.rn rya,
AP(`F Notary Public - State of Florida
Commission # FF 956571
SIX nda:= My Comm. Expires Apr 25, 2020
"` Bonded through National Notary Assn.