HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
SCANNED
BY
BUILDING PERMIT St. Lucie Count%
SUB -CONTRACTOR SUMMARY
Florida Mechanical LLC will be using the following sub -contractors for the
(Company/Individual Name)
project located at 1664 Walton RD, Port St. Lucie, FL
(Street address or Property Tax ID #)
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
Malanczyn Electric
EC-0001492
Plumbing
HVAC/
Mechanical
Roofing
Gas
Structural
WA76011
ISSUE DATE:
Revised 07292014
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): e - j� e oeyo / K 1 2
of Trade)
c lcC��e<<
SGANNED
BY
St. Luce Count,,
have agreed to be the
Sub -contractor for Florida Mechanical LLC
(Primary Contractor)
For the project located at 1664 Walton RD, Port St. Lucie, FL
(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:
Address:
City/State/Zip:
Phone:
SIGNATURE
3 7 ��
`7762 �3 rj'/ %. 5' email: s,"CzS,z 42
PRIN AM` `�
6 ZZ /1
DATE
STATE OF FLORIDA, COUNTY OF �0A/ '
THE FORE7,/'&�
G INSTRUMENT WAS SIGNED BEFORE ME THIS �i DAY OF , 20/�
BY h��ofiR�f • C//lI WHO IS PERSONALLY KNOWN �"/% OR HAS
PRODUCED
AS IDENTIFICATION.
NATURE OF NOTARY P LIC PRINT NAME F NOTARY PUBLIC
SLCPDS: 08/06/2014
(STAMP)
JFITREY B HER W
r * MYCOMMISSN)NIIEE220422
,d EXPIRES; November20, 2016
�l4"4o,Ro"" Gonded 7Nu6udget Nol�Services
,f