HomeMy WebLinkAboutSubcontractor Summary AND DEVELOPMENT SERVICES DEPARTMENT
a Building and Code Regulations Division
BUILDING PERMIT
SUB-CONTRACTOR SUMMARY
will be using the following sub-contractors for the
(Comps /Individual Name) p
project located at. �C5 52c�9.,('c � Dayy-e (t� ( 1 tfC, Q,• PL 3q 9 8 9
(S eet ad ess 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 ( ��u
Plumbing
HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMIT ISSUE DATE.
NUMBER:
Revised 07/29/2014
RECEIVED M 3 0 116116
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):
a�L'SQUa �Ueo e— have agreed to be the
( ompany Name/Individual N ) -S��
Sub-contractor for
(Type of Trade) (Primary Contractor) ,
For the project located at
(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:
Address:
City/State/Zip:
Phone: email:
�s U3me_ L(,o
VSIGNATUkE PRINT N&ME U DATE
STATE OF FLORIDA,COUNTY OF 1
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS <�UDAY OF ��V ] .20 tc
BYUCzC 1&Q-WHO IS PERSONALLY KNOWN OR HAS
PRODUCED li- AS IDENTIFICATION.
SIGNATURE O OTARY PUBLIC P T NAME OF NOTAR PUBLIC
SLCPDS:12/16/2013
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