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):
`-YYl 11 have agreed to be the
(Comp Name -ndi ' ua am
Lef Sub-contractor for
(Type of Trade) (Primary Contractor)
For the project located at
(Project Streel AddreA 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: '
Address: y
City/State/Zip: y
Phone: 77 — email:
C O:z US
SIGNATURE
STATE OF FL RIDA,COUNTY OF
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF ,20_)_�)
BY WHO IS PERSONALLY KNOWN OR HAS
PRODUCED AS IDENTIFICATION.
I (STAMP)
SIGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS:08/06/2014
KAREN S. NIELSEN
yB`n'""
Commission# FF 115637
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oc My Commission Expires
",fFOFn,ao•°:�' June -12, 2018
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