HomeMy WebLinkAboutSubcontractor Agreement PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
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BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
St.Lucie County Contractor Certification Number:
State of Florida Certification Number(If applicable): C.r-C Z ?�
� Ciz have agreed to be the
(Compan Name/Individual Name)
,PU MN.2 f Sub-contractor for JO�rt,n
(Type of Trade) (Primary Contractor)
For the project located at a aD a �. Ave,y� , , i-t l�nn
i e�rck
(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: Lk M1 -k
Address: 0A.S.10
CV Y_—F . /+
City/State/Zip: i is
Phon - — email:rd A �dil1(� OD
ea
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9 ! 15
ATURE PRINT AME DATE
STATE OF FLORIDA,COUNTY OF _'54— W r IL
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS I Z*DAY OF NOvQ_W,'* ' -,20-1!r?—
BY
20 I�
BY S �:L p`(�g d� C \�Z p aA T1� C�— WHO IS PERSONALLY KNOWN ✓ OR HAS
PRODUCED AS IDENTIFICATION.
• � " � (STAMP)
�u`7l2 �2'rl�cCF��I��
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS:08/06/2014
11 b. SUSE IGII7ML
t MY COMMISSION f FF M22
EXPIRES:September 13,201
° ...... Bended Thru N"y Pubfic wenrtiters
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Product Aeeroval Ptenu>Product or Aoolica[ion Search>Aooliwtion list>Application Detail �.
FL.#. L1435-R16
' Application Type'' Revision
Code Version 2014
AppiicatiomStatus Approved -
'Approved by DBPR._Approvals by-DBPR shall be reviewed and ratified by the POC
-. and/or the-Commission if necessary.
Comments .
Archived
Product Manufacturer .PGT Industries
Address/Phone/Email 1070 Technology,Drive"
. .. - Nokomis,.FL34275
(941)486-0100. Ext 22318
druark@pgtindustries.com
Authorized Signature - . - -Jens Rosowski
jrosomki@pgtindustries.com
Technical Representative - - Jens Rosowski' -
Address/Phone/Ercall 1070 Technology Drive -
Nokomis,FL 34275 -
(941)486-0100 Ext21140 - - '
jros6w5ki@pgtindustries.com.
Quality AssuranceRepresentative - - -
Address/Phone/Email - - -
Category - - Windows - - -
Subcategory. Single Hung
Compliance Method Certification Mark or Listing -
Certification Agency Keystone Certifications,Inc.
-" Validated By 'Steven M..Urich,PE
-Nn,'.�Validation Checklist Hardcopy Received'
Referenced Standard and Year(of Standard) Standard - ,- Year
- AAMAJWDMA/CSA 101/IS2/A440- 2011 '
".AAMA/WDMA/CSA 301/IS2/A440- - 2005
" AAMA/WDMA/CSA 1011IS2/A440 2008
ANSI/AAMA/WDMA,101/I.S.2/NAFS' - 2002 .
ASTM E1886 2005.
. - ASTM E1996 2012
.. - - - - ASTM E283 '2004
ASTM E330 2002
Equivalence.of Product Standards - - -
Certified By
h4://floridabuilding.org/pr/pr_app. dti.aspx?puam=wGEVXQwtDgsbCUlTl<-el20DuttTa 8/19%2015