HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division SCANNED
BUILDING PERMIT St. Lucie County
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): CCG .{/j!� ;59 6 3
,4C/G!-142 D !G !/A f//J GONIT. C gAP. have agreed to be the
(Company Name/Individual Name)
Qo2l /N6 Sub -contractor for Q/G414.&P A 111Y 4L4/Z t;o¢P.
(Type of Trade) ��411 yo�o,4G(Primary Contractor)
For the project located at
Street Address or Property Tax
//1—�Jrj�j-� —
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)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name: R/GHg114> k _4111/l Co/✓tr. CO,
Address: P Pjpz6A
City/State/Zip: A07' PIEACE _ Ai Ao'ftG
Phone: 7%2 — AhI L-8 email: a-j?r%e @
SIGNATURE PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF f7 L
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS &"DAY OF �f/1aGH , 20Z(,'
BY %PO1161Af P4V1-f WHO IS PERSONALLY KNOWN OR HAS
PRODUCED J
FS G TURF OF NOTARY PUBLIC
LCPDS: 08/06/2014
PRINT
AS IDENTIFICATION.
OF NOTARY PUBLIC
% RUG'ERR. PRIEST
Notary Public - State of Florida
My Comm. Expires Nov 7. 2016
Commission # EE 217267
Bonded Through National Nolary Assn.