HomeMy WebLinkAboutFILING OF STATE CERTIFIED CONTRACTORSBOARD OF
COUNTY
SCANNEDCOMMISSIONERS
BY
St. Lucie County
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s
PLANNING & DEVELOPMENT
SERVICES DEPARTMENT
Building & Code
Regulation Division
FILING OF STATE CERTIFIED CONTRACTORS
Please complete the following form and return the:ORIGlNAL signed and notarized to St.
Lucie County Contractor Licensing Department, along with the. checklist below:
LICENSED QUALIFIER NAME
Lou IS
COMPLETE
HOME ADDRESS
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HOME PHONE
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E-MAIL ADDRESS
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BUSINESS NAME
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COMPLETE
BUSINESS ADDRESS
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BUSINESS PHONE AND FAX
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E-MAIL ADDRESS
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Please make sure that the Business Entity Name;; Workers' Compensation and Liability
insurance, all match the State Certified License.
Provide a Certificate of Insurance for Workers' Compensation and General Liability directly from
the Insurance Company with the certificate holder's address reflecting as follows:
St. Lucie County Contractor Licensing,-230D Virginia Avenue, Fort Pierce, FL 34982
2. Provide a copy of the License provided by the Florida Department of Business and Professional
Regulation.
3. A clear copy of the qualifier driver's license.
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COUNTY OF
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MY COMMISSION &"'-
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CHRIS DZADOVSKY, District No. 1 • TODD MOWERY,DistrictNo.2 • PAULAA. LEWIS, District No. 3 • FRANNIE HUfCHINSON, DislrictNo.4 • KIM JOHNSON, District No. 5
2300 Virginia Avenue • Fort Pierce, FL 34982-5652 • Website: www.stiucleco.org
1CONTRACTOR LICENSING: (772) 462-1672 • FAX: (772) 462-1148 Email: contractor IicensinaAstlucieco.orri
. CODE ENFORCEMENT: (772) 462-1571INSPECTIONS: (772) 462-2165 PERMITTING. AND ZONING: Phone (772) 462-1553 FAX (772) 462-1578 -