Fillable SUBCONTRACTOR AUTHORIZATION (Brevard County Board of Commissioners)

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SUBCONTRACTOR AUTHORIZATION (Brevard County Board of Commissioners)

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BREVARD COUNTY BUILDING CODE
2725 Judge Fran Jamieson Way, A114
Viera, FL 32940
(321) 633-2187 phone
Email: InspectMail@brevardfl.gov
SUBCONTRACTOR AUTHORIZATION
Site Address
*Building Permit Number
Street City State Zip Code
I hereby authorize the following contractor or individual to include me as a subcontractor for the
referenced job.
*Full Name of Authorized License Holder or Property Owner *License Number
Subcontractor Information
*Full Name of License Holder *License Number
Phone Number
Type of Work
Plumbing Electrical Mechanical Roofing Specialty
Signature of License Holder (subcontractor) Date:
Subscribed and sworn to before me, by _____ physical presence or _____ online notarization, this ____ day of
, , 20 , personally appeared _____________, who
is personally known to me or produced ___________ _____ as identification, and who did/did not take an oath.
Notary Public Signature Seal
Sub Auth 9/28/2018
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SUBCONTRACTOR AUTHORIZATION (Brevard County Board of Commissioners)

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Completed 1 April 2021

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