HomeMy WebLinkAboutSubcontractor Summary and Subcontractor Agreement PLANNING & DEVELOPMENT SERVICES DIVISION
BUILDING&CODE REGULATIONS DIVISION
• _ 2300 Virginia Ave
-- Fort Pierce,FL 34982
_ . BUILDING PERMIT
- SUB=CONTRACTOR=SUMMARY - -
- -
bofor theusingthe following su —
( ompany/ n ividual ame)
roject located at
-(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.
_ St:Lucie-County/ -
Trade Name of Company/Contractor State of Florida
License Number
Electrical
Plumbing
_ HVAC/
Mechanical
Roofing
Gas--
OFF-ICE
as-OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERYHT
SUB-CONTRACTOR AGREEMENT
St.Lucie County Contractor Certification Number.
State of Florida Certification Number(if ficabte):
�ezem � have agreed to be the
(Company ame/Individual Name)
c:- sub-contractor for
ype of Trade) ss (P ' ontractor)
for the project located at
(Project Street Address or Property ax 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 ofthe Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address:
City/State/Zip:
Phone: email:
"NAT PRINT NAME DATE
STATE OF FLORIDA,COUNTY OF )I'. - c*x
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME TRIS. �1 DAY OF W\0,y ,201
b'z s r+r "0 IS PERSONALLY KNOWN—OR HAS PRODUCED L
-- Q,6
f
TIFICATION.I,� r_)_ 4
OF NOTARY PUBLIC ►7 PRINT NAME OF NOT �,yc° m�ss`0 Na��O�a,
Y �
OFFICE USE ONLY:
PERMIT# ISSUE DATE