HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTPERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division SCANNED
e BY
BUILDING PERMIT Lucie COUnty
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number.
State of Florida Certification Number (if applicable): I�tl-'1 l51 b
have agreed to be the
for
of Trade)
(Primary Contractor)
For the project located at 8aoD S u SA— % r� (� LuC Q (,
(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)
QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
j � l � � �j
Business Name: , WUx t 'A V' Q l_.C. I `'�-� -�
Address: (71 �4A P fo ^ ^ City/State/Zip: 1(31 mil.
Phone:/, 0 email:j�=aY��,�b11 ID(1�Pi'nb Y9
IMO
26W "a CA,
t DATE
5•I'ATE OF FLORIDA, COUNTY OF(l•F�-�
THE FOREGOING
NSSTRUM�EN�T�WAS SIGNED BEFORE ME THI� DAY OF ( 20L
BY J�) h' \ I I l�-X QL�C_I WHO IS PERSONALLY KNOWN OR HAS
PRODUCED AS IDENTIFICATION.
f STAMP
k!;_ ROCHELLE LEE DAGGETT
SIGNATURE OF NOTARY PUFUId PRINT NAME OF NOTARY PUB I
MY COMMISSION #FFI85075
SLCPDS: 08/06/2014 _ ", Ind',:f EXPIRES December 22, 2018