HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
SGANNEL,
BUILDING PERMIT BY
St. Lucie C011nt�
SUB -CONTRACTOR SUMMARY
Florida Mechanical LLC will be using the following sub -contractors for the
(Company/Individual Name)
project located at 101 Melody Lane Ft. Pierce, 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
RVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
Revised 0729/2014
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 (ifapplimble):
Z
(Type of Trade)
For the project located at
Name)
�
SCHNNEL
St. LUCI@ Colmt,
have agreed to be the
Sub -contractor for Florida Mechanical LLC
(Primary Contractor)
101 Melody Lane, Ft. Pierce, 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: /,?< S0 / 1
City/State/Zip: 69/�,t-ZS ;6 lyct
Phone: 77.2= 2rSS 1 �.Z`7��nl
le
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email: �Mo �FJCzya7� �vv� �M
e
SIGNATURE PRI N ME DATE
STATE OF FLORIDA, COUNTY OF Glfr Fa
THE FOREGO/Ij�G INSTRUMENT WAS SIGNED BEFORE ME THIS �� DAY OF 20l z
BY if./O�G� WHO IS PERSONALLY KNOWN OR HAS
i
PRODUCED
AS IDENTIFICATION.
NAT O NOTARY PUBLIC PRINT NAME
SLCPDS: 08/06/2014
(STAMP)
1 ,VA > AiAWWBMERLW
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