HomeMy WebLinkAboutSubcontractor Agreement PERMIT# 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(If applicable):
have agreed to be the
`` (Company Name/Individual Name) I
1 PC g CC_ Sub-contractor for
(Type of Trade) (Primary Contractor)
For the project located at 1�6 1 S Q an- a.
(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)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name: ffil
Address: U
City/State/Zip:
Phone: ?��— J2� email: S a Cc c�� C,-On
eS WUQ21 (Q-12A�—:)
SIGNE PRINT NAME DATE
STATE OF LORIDA,COUNTY OF *A WCJ if,
THE FORE GING INSTRUMENT WAS SIGNED BEFORE ME THIS �bAY OF ,20 1
BY QJ WHO IS PERSONALLY KNOWN OR HAS
PRODUCED AS IDENTIFICATION.
ti
(STAMP)
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS: 08/06/2014
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