HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENT1P
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PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Coale Compliance Division
® SCANNED
BUILDING PERMIT BY
SUB -CONTRACTOR AGREEMENT St. LOCI@ CODUry,
St. Lucie County Contractor Certification Number: /� 1
State ofFlorida
'Certification Number (if applica�ble):
C
a I�(�1�'l� �� nU C A 1 ra al Ll ( Oii-\, have agreed to be the
(Type of Trade)
For the project located at
Sub -contractor for
(Primary Contractor)
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)
QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address:
City/State/Zip: h'
t
Phone: l Oa ail: } ( �'SLA�I-i'1Peahr—H 1 11 PrPJ
/�{ N URE PRINT N'A,M.E/ ATE
ATE OF FLORIDA, COUNTY OF
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF (I 20_Ltp
BY �_' O�R I 1 WHO IS PERSONALLY KNOWN OR HAS
PRODUCED
SIGNATURE OF NOTARY F06AIC
SLCPDS: 08106/2014
IDENTIFICATION. -.
I(STAMP)
PRINT NAME OF NOTARY PU
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{fir " �'�� � y
ROCHELLE LEE DAGGETT
-
MY COMMISSION #FF185075
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w7) 309a153
EXPIRES December 22, 2018
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