HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTu
r i PLANNING & DEVELOPMENT
SERVICES
CMS DIN SION
V�
2300 Virginia Ave
Fort Pierce, FL 34982
BUILDING PERMIT SUANNED
SUB -CONTRACTOR SUMMARY , Ry
Bea')
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iJeg rJ 1 rJ G S �� C/�i( �S� / �cti will be using the following sub -contractors for the CO���
(Company/individual Name) !—,4
/� / ;
project locatedat SI%y'% L/n/oi kc J'/� 2a4, d<.(�
(Street address or Property Tax ID tl)
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
/
A W m G ', c Ts�a rrr �{ ✓��
Plumbing
HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
St. Lucie County Contractor Certification Number:
State of Florida
Sub -contractor for
For the project located at
SCANNED
BY
St. Lucie Countv
have agreed to be the
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
Business Name: �l'��f'ifO lc& 4
Address:
City/State/Zip:
email:
PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF i e. I
THE FOREGOING INST
RUMEN
T WAS SIGNED BEFORE ME THIS 69 DAY OF � � 20_/I�
BY WHO IS P ALLY ENOR N OR HAS
PRODUCED AS IDENTIFICATION.
1 Y K� 1��C f Iq (STAMP)
PRINT NAME 04 NOTARY PUBLIC
SLCPDS: 0k '2 "�^'t" LIBERTYAIONG
N'z
r h9Y COMMISSION 9 EE 877248
�*.?„p Bonded ThrluNEolSeryP.bfct rxNers
u
PERMIT# T
4 9,). ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
•
BUILDING PERMIT s /lldlyE®
SUB -CONTRACTOR AGREEMENT St
lll(ey
Copy
q cy IA
St. Lucie County Contractor Certification Number: op��o % I / `y
State of Florida Certification Number (If applicable):
4im c 1r�c � J a,✓n %n/ Ab have agreed to be the
(Company Name/Individual Name) r--L (eGi-/I -E / Sub -contractor for de 4+'/w� ee4_
(Type of Trade) (Primary Contractor)
-- For the project located at SO y 7 % ✓r,vy, /4 re ee& i /2,(.
(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 l pme: }y'((rl mG
Address: Wig
City/State/Zip:
Phone: 2 79- .216 - 5`!S-�Z email: czp COYI4 Ca ST. tie
/J —7462
PRINT NAME DATE d
STATE OF FLORIDA, COUNTY OF ' . \ �, s ece �I
THE FOREGOING INSTRUMENT-WAS//SIGNED BEFORE ME THIS DAY OF (JG�o4L/ 20/
,S
BY 'S 44E,,/1 &)e,4/� WHO IS PERSONALLY KNOWN [�-' OR HAS
PRODUCED AS IDENTIFICATION.
O1Nw (STAND" RAULERSON
2�s"Z- ✓�L act svl in %�2u �2lscr7 Notary public - State of Flo[IOrt
SIGNATURE OF NOTARY PUBLIC, PRINT NAME OF NOTARY PUBLIC 'Commission FF f18S5/S
My Comm. Eapiraa Fab 28. 2021
SLCPDS: 08/06/2014
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