HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTCOUNY� �=
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and CodeRegulations Division
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
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351Y0 A sIg r7 will be using the following sub -contractors for the
(Company/Individual N,a/me) }
orniect located at, `"t p / �1 d. W a-L) ^-ba j F� be rC e
It.is understood thabif there''is any change ofstatus regarding theparticipation of any ofthe sub -contractors
listed belo v, I will immediately advise the`Bnilding and Z616Department of:SL Lucie"County,
Trade
Name of CompanylContractor
St: Lucie County/
State of Florida
License .Number
Electrical
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Plumbing
HVAC[
Mechanical
Roofing
Gas
PERMIT
ISSUE DATE:
NUMBER:
Revised 07292014
PERMIT# lssU DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance.Division SCANNED
BY
BUILDING PERMIT St Lucie Countv
SUB -CONTRACTOR AGREEMENT,
St. Lucie County Contractor Certification Number:
State .ofFlorida-Certification Number (If applicable):��--
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For"the project -located
have. agreed to be'the
Sub -contractor for �3a m n \f Cl n
(Primary Contractor)
fnfj
roj'ect.Street Address or Property
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It is understood that, if there., is any change of status regarding our participation with the above mentioned
project, I.wih, immediately advise the Building and Zoning Department of St. Lucie County by'ffling a
Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00)
BUSINESS QUALIFIER (Name of the Individualshown on the.Contractor's License)
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NOTARIZED SIGNATUR��EyyS ARE REQUIRED
Business Nam 7�/, F.!)1IIJYY
'Address: '` r Q�3 - 7L �•
Phone: % S % email:. 44 ,i/� I'I • �G�!� l
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'SIG TURES - `PRINTN:ISIE •. 'DATE --
S ATE OF FLORIDA, COUNTY. OF ST 4:be ! L
THE FOREGOING _
INSTRUMENT
NSTR —MENT WAS `SIGND_E�BEFOREME THIS! DAY OF 1i� - , 2
BY 6�)-a jc/F('-) /a_ yy, WHO IS PERSONALLY KNOWN L-' OR HAS
PRODUCED, AS;D)ENTIFICATION.
(STAMP)
SIGN RE-OFNOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
'SLCPDS: 08/06/2014
oa"• �e, KATHLEEN J. VERZARI)
�: h' Notary Putilic Slaledl Florida
m�8 mi comm:'&pnes Jun 14, 201a
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Commission MFF 121335'