HomeMy WebLinkAboutSUB CONTRACTOR SUMMARY-AGREEMENT;r�a• ,.°",sv' PLANNING & DEVELOPMENT SERVICES DIVISION
BUILDING & CODE REGULATIONS DIVISION
° 2300 Virginia Ave
Fort Pierce, FL 34982 -
BUILDING PERMIT SCA
SUB -CONTRACTOR SUMMARY
A i . t; 1;-
St. Luglp,C,ount)c.
AW-11 be using the following sub-confrai�OA`ibP4he
(Company/Individual Name) _ I
project located
(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
Plumbing
HVAC/
Mechanical
Roofing
Gas
OFFICE FUSE ONI>Y
PERMIT ISSUE DATE:
NUMBER:
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
I = Building & Code Compliance Division F e
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT AUG i & ii
PEM!-,IT� M'ti
S't. _LCie (.CU'It)" + l-
have agreed to be
(C mgany Name/Individual Name)
the (�L//%7 A /X J Sub -contractor for
(Type of Trade) (Primary Contractor)
For the project located at
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 -contract otice.
ONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
aACTOR SIGNATURE (Qualifier)
2T < rd /--u {iXj
PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida, County ofe� K-Lr ' '° ' State of Florida, County of
e forego(ng instrumentwas signed tefore me this
1Wday of \ The oregoing Instrument was signed
�before me this day of
21/2
eczz
who is personally known -r has produced a who is personally known �vnas produced a
asf H���ion. t en ion.
1 _
STAMP AMP
Sign urc of Notary Pu ature of Notary ublic
Print Name of Notary Public
.�• "nor SHERRiFFs7urlAPl
*MyCOMMdSSIONtFF100'1'0
Revised 111162016 EXPIRES:6larlry,5 N1es
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Print Name of Notary Public
p rDaBOc SHERNFEdUlAN
MY COMMISSION # FF 100370
EXPIRES: Match14,2018
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