HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTproject located
-- PLANNING & DEVELOPMENT SERVICES DIVISION
BUILDING & CODE REGULATIONS DMSION
2300 Virginia Ave SCANNED
Fort Pierce, FL 34982 BO
BUILDING PERMIT St Lucie County
SUB -CONTRACTOR SUMMARY
will be using the following sub -contractors for the
(Company/Individual/Name) //
at rl z3a U7
,(Street address or Pr6perty Tax D) #)
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
Plumbing
Fxeeklp QooT/
LIF6 )4agasy
HVAC/
Mechanical
Roofing
Gas
OFFICEIJSE ONLY;.
PERMIT ISSUE DATE:
NUMBER:
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
SCANNED
BUILDING PERMIT BY
SUB -CONTRACTOR AGREEMENT St. Lucie County
St. Lucie County Contractor Certification Number: AA
State of Florida Certification Number (if applimble): ,,F6 jgd7R5J7
�XLG�SlDf C9At5fPuG�iDV 4 fie+ irU¢ �(�edi>i/ l�. /[/lQ 1 �i'a5o have agreed to be the
(Company Name/IndividualName)"
PIUMbiy4 Sub-contractorfor E-XI;ClS%d('
(Type of Tr de) (Primary Contractor) '
For the project located at 663Q S 1W AL/ y/q e 1 /, r zael et FL 3,
(Project Street Address orProperty 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)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATUR/ESS ARE REQUIRED
1 r
Business Name:
Address: IS$'d � CfDt-lbel'rV Dr,; Ve
City/State/Zip:
Phone: email:
SIGNATUR PRINT NAME �' DAT
STATE OF FLORIDA, COUNTY OF
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF
BY
PRODUCED
SIGNATURE OF NOTARY PUBLIC
SLCPDS: 08/06/2014
20
WHO IS PERSONALLY KNOWN OR HAS
IDENTIFICATION.
PRINT NAME OF NOTARY PUBLIC
(STAMP)
06/08/2016 3:41 PH FA% 7723372699 RENT-11LOSSER
0 0001/0001
PERMIT # 11 . C)q y O1 [gyp r-ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
- - Building & Code Compliance Division R � f D
DE
• BUILDINGPERMIT St. Bt ($o
SUB -CONTRACTOR AGREEMENT `Y
PERNiITTI,NlG
St. Lucie County Contractor Certification Number: 2061 S St. Lucie County, FL
State of Florida Certification Number arawn-ble): EC13001570
Blosser Electric have agreed to be the
(Company Name/individual Name)
Electrical Sub -contractor for Excelsior Construction & Rot
(Type of Trade) (Primary Contractor)
For the project located at 6630 US 1, Port St Lucie, FI 34952
(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)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
BusincssName: o1 >-S f rinC,,
Address: PO Box 7305
City/statc/Zip: Port St Lucie, FI 34985
Phone: 772-337-0055 cm il: nrblosser@gmail.com
Kent Blosser 6/7/16
SIGNATURE PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF 57- L tCAx.
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS ?4-'- DAY OF TP. -e- 20 I CD
Y
BY 0f J 10 SS e r _WHO IS PERSONALLY KNOWN OR HAS
PRODUCED FL/71 _ AS IDENTIFICATION.
�C7
QIA.tAA O {a� tsfWly�( G•F?S2coz' (STAMP)
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS: 09/Oti/2014
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