HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTCp# ^
PERMIT it 1 ..O (_y OQ ISSUE DATE
MMONMEh PLANNING & DEVELOPMENT SERVICES
9TM �', , Building & Code Compliance Division
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"_. . _w .._ .. BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: �) /-/ � 9-
State of Florida Certification Number (Irapplicable): C G 13Ci /J a j 7 rJ
re Uie / ev yr t,
i SCANNED
SY
St. Lucie Coum,
ECER'ED
JUL 18 201E
PEP,MIT MG
St. Lucie County, FL
have agreed to be the
(Company Name/IndIVIdnal Name)
C— ( e C -(r , 4 1 Sub -contractor for
(Type of Trade) (Primary Contractor)
For the project located at / CJ 7 LJ 1 S G C r ra to Q A— i7 r - fi,,, l Fe
(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
Business Name: G1— S � j Yc• �'r'' ,r
Address: .S-I �7�7' %L-c 1'7,' —, K- S' Y
City/State/Zip: l!� j ..S I L... c.0 : cam /. / —7 c f 1 s' .7
Phone: 3 7 ` (3 S'-7 email: ,1,v /.*1._ <`/_S;t'C..f,I. Lsr:-...
SIGN URE PRINTNAME DATE
STATE OF FLORIDA, COUNTY OF.. THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS _ / DAY OF ` , 201(0
BY WHO IS PERSONALLY K4WN J OR HAS
PRO OUCED AS IDENTIFICATION.
A101: hJ- 44 (STAMP)
PRINT NAME OF NOTARYPUBLIC !''•`,+:<. ANNE BROWN WALMACH
SIGNATURE OF NOTARY PUBLIC MY COMMISSION # FF984603
SLCPDS:OS/06/1014 4Pa EXPIRES April21,2020
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;i+• ``�';; NNE BROWN WALMACH
MY COMMISSION # FF084083
EXPIRES April 21, 2020
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