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HomeMy WebLinkAboutSUB-CONTRACTOR SUMMARYPLANNING & DEVELOPMENT SERVICES BUILDING & CODE COMPLIANCE DIVISION SQA �NED BUILDING PERMIT St' RUC/@ CoUn SUB -CONTRACTOR SUMMARY L�11i4✓d�/oc/C will be using the following sub -contract ors for the (Company/Individual Name)AbM RI Il�C�9- project located at ��67/�• -0,- l✓J : p (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 J i 5 n5 0287�� OFFICE USE ONLY: PERMIT ISSUE DATE: NUMBER: I�-tio2: O PERMIT #F I 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 (inapplicable): SN,PI/!bd l=W7740W W cCl�itwl.L�s /n/6 o1Dffi✓ C f�.r� have agreed to be the (Company Name/Individual Name—/ _5t4A 1 Sub -contractor for (Type of Trade) (Primary Contractor) For the project located at /3Y49a 6/490 ✓ g9467 (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) QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNATURES ARE REQUIRED Business Name: 814X4Gmtd B"rhtAM-S 5t/ .e � 6imr�G�Jw/G, Address: / 36/ n?AJ &7 A14 4Rsr/LI A,-C' Al City/state/zip: _s.Lre i& _;P 3 fo5-'r ao email: GAitn/G. r (9 &¢e4ve,• PRINT NAME DATE ' ' STATE OF FLORIDA, COUNTY OF pr ✓1 Q LL THE FOREGOING INSTRUMENT WAKS GNED BEFORE ME THIS I ' DAY OF /vL� / , 20�� 1F BY � D kn L " &Ly lrL is WHO IS PERSONALLY KNOWN V OR HAS PRODUCED AS IDENTIFICATION. (sTAW) SIGNATURE OF NOTARY PUI PRINT NAME OF NOTARY PUBLIC SLCPDS: 12/16/2013 NDNA C. LEE ffm NotaryPublic - State o1 FbrWY . Expires Apr 2S, 2017sion # Ft 000621upA Noble! %dry Alin, PLANNING & DEVELOPMENT SERVICES DIVISION BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave Fort Pierce, FL 34982 BUILDING PERMIT SUB -CONTRACTOR SUMMARY B4.&9jk&S A/LOn 91geir /0will be using the following sub -contractors for the (Company/Individual Name) %C C. project located at U Ll lS— 7 u►— B u 3 f— b u v- 5 (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 01 rZ .1iuG. a R657 FG Ilao6S/7 Plumbing HVAC/ Mechanical Roofing Gas f Mr..F, IiSF, ON F,V: PERMIT n ISSUE DATE: NUMBER: C r� PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: _ a %65-1 State .of1Florida Certification Number (If applicable): C /-L L 61) W t r,eylu+7- Il C_ have agreed to be the (Co pany ame/Individual Name) C 2 (Co Sub-contractor for (Type of Trade) For the project located at LN a S- 70 / - 6031 - ODU - (Project Street Address or Property Tax ID /I fu', I A0 til�s , h ce P ��, , (Primary Contractor) 5rIn/�S IF dr'P116cs,7nc, 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: SLCCDY (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: 1"Fr1"Clef — n 511111 Phone: t4In L - 04;-aj email: cwl E4 &" L&Ne-u 1t(fiy SIGNATURE PRINT NAME DATE STATE OF FLORIDA, COUNTY OF �. 1LLt 4:1' THE FOREGOING IN1ST,RUMENT WAS SIGNED BEFORE ME THIS 1-14fiDAY OF 20 tP BY Lf t L WHO IS PERSONALLY KNOWN OR HAS ED AS IDENTIFICATION. C r f C e/ (STAMP) IRE OF PUBLIC PRINT NAME OF NOTARY PUBLI / 12/16/2013 •""""' LAURIE C. SNYOER Notary Public -Stale of Florida ` = My Comm FRplles Aug 1, 2017 •''' Commission a FF 041047