HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENTPLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
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SCANNED
St. Lucite n
"��fyFOsY
APq _1 0
APB/n9 O 7q lg
IsC y" 'P r`oa N
rq1..1 ent
have agreed to be
the :PI (4'V J of S Sub -contractor for V IYA w o y �^ s�✓ti �� , u S
('Type of Trade) (Primary Contractor)
For the project located at 3 5 O
(Project
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.
/�jJC�TOR SIGNATURE (�uatifier)
/
PRINT NAME
'SUB -CONTRACTOR SIGNATURE (Qualifier)
2
PRINT NAME
SHIM
COUNTY CERTIFICATION NUMBE COUNTY CERTIFICATION NUMBER
UUM BER
C3 G- ti 2`'_`g _'45;y i
State of Florida, County of State of Florida, Comity ofc�-- --� The for Ding instrument wwas sign�/�71�t�,efore me this dayy^of (� The foregoing instrument was signed before me this
(� day of
20 (by / 1. /� V t �! l .20�by l7'lii �llJ �' l )Li }) 0 Ti
who is pe�own ✓ or has produced a who is personally (mown _or has produced a
as i//////dddddd�������ppppppn 'nation. as idenn don. /' ` 5 G `O Q 6 3
� r ,1 �DP.1/�e�i nt n,rt�L.jf/ I""r STAMP h%
^kaghat((ure of )Notarublic
kN 14'�/A</
Print Name of Notylry Public
EdTitsufroypaininsum"gitoo,335.1019
RLEYK.SEMENDERFER
mission#FF989655
es May9,2020
Revised 11/16/2016 0.3ab7019
S4L (Y \-eP l 14e✓h 60d
Print Name of Nalary Public
SHIRLEY K. BEMENDERFER
`, Commission # FF 989655
4: Expires May 8.2020
'v.;g;�;; 4•' Baled Rau Tmy Fainlnsumna 800.1[S1e1!
i
EviliAN RIVER COUNTY/CITY OF VERB -EACH
COMBINATION PERMIT
SUB -CONTRACTOR AGREEMENT/AFFIDAVIT
will be conducting the work for the following trades
(company/individual name)
for permit #
Comp Card #
located at
under my license
(street address)
and not sub -contracting out this work. It is understood that, if there
are any changes in status regarding any of the work indicated below, I will immediately advise the Indian
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�' ] i •'1 i F� .
___ �, PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
RECEIVED
BUILDING PERMIT APR i 0
SUB -CONTRACTOR AGREEMENT 2018
Permitting Department
St. Lucie County
5 mj 4-� CE (e c4,_ i c have agreed to be
(Company Name/Individual Name)
the Gl I c Sub -contractor for, V ///J-jJatla.. 6,-J 5 i-ki Ad-i
(Type of Trade) (Primary Contractor)
For the project located at
3sa1
(Project Stree'
G6-hN AA —
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.
�CONTAACTOR SIGNATURE (Qualifier)
PRINT NAME
- N
SUB -CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME Ctfl
(0�
COUNTY CERTIFICATION NUMBER COUNTY CERi CATION NUAMR
State of Florida, County of�cc"6� State of Florida, County of /J
nc:rp
��The foregoing instrument was sign before me this daylof/ The foregoing instrumen'towas signed before me this yr' day of
20_dby Vi �I f% 20/ Lby �G�L.� `-?'IYJ
who is personally known or has produced a who is personally known _or has produced a rl
as identification. S ✓ O �� /W�
as id 'cation. , v
Signature of /Notary Public /f J
y cli l'G! K(_:�eb* rZf/I /� PhDiC/
Print Name of Notfy Public
Revised 11/1612016 9=1
Q)nlYl 4 14 1>11P_rn e_i�GI1
Print Name of Notalry Public
•,r,,:.,g� : SHIRLEY K. BEMENDERFER
Commission 9 FF 989655
-'•, j ' ` Expires May 8, 2020
;,, ,, •' Bonded TMu Roy Fain lnsurants808-3857019
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