HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTt:111111.1
Verizon PC'
69032
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
SCANNED
By
St. Luce County
Ascend Wireless Networke6arth F Gahlberg
(Company Name/Individual Name)
the E�I tk,+r( Q-0 -Sub-contractor for
(Type of Trade)
For the project located at 16800 OKEECHOBEE RD
PRECE ED
MAR 0 9 2017
PERMITTING
St. Lucie County. FL
have agreed to be
Ascend Wireless Network zr. c
(Primary Contractor)
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, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CONTRACTOR SIGNATURE (Qualifier)
MO-4 Zt J4L6ac%
PRINT NAME
a1G b
COUNTY CERTIFICATION �NNU,�M,, B,�,E,RR� �� ��
State of Florida, County of fAana l a
The foregoing instrument was signed before me this 24 day of
kl2aA20j2by �7af�
whoispersonallylumwn tO�orhasproduceda
asidentifir IAi n.
\$illnature of NotaWl'i(blic
n`Sf
Print N13�
" Public, Public Staten on
Lacey N Stovall
My Commission FF 108131
° Expires04/182018
Revised 11/162016
SUB -CONTRACTOR SIG URE (Qualifier)
PRINT NAME
7-: 007s4 S
COUNTY CERTIFICATION NUMBER
State of Florida, County of CrCk Q
The foregoing instrument was signed before me this-G day of
who is personally known or has produced a
as identification.
STAMP � "�2 ^tix n /—: —E STAMP
Signature of Notary Public(
Print Name of Notary Public
RMN
A LYNN CARMEANMISSION #FF187738 January 7, 2019Nate 3ervice.com