Fillable Sub-Contractor--Form TO BE COMPLETED BY

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Sub-Contractor--Form TO BE COMPLETED BY

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Country of origin: US
File type: PDF

U.S.A. forms for Town of Fort Myers Beach

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Sub-Contractor Confirmation Form
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931
Page 1 of 1 Phone # (239) 765 -0202 Permits@fmbgov.com Fax # (239) 765-0909
Permit # ______________ Primary Contractor: _____________________________________________
Job Site Address:_____________________________________________________________________
The qualifier of each sub-trade (electric, plumbing, mechanical, roofing) performing work under a
general contractor must complete this form and submit it to the Fort Myers Beach Permitting Department
before the permit is issued. This form must be notarized and an original copy must be submitted.
Sub- Contractors Information:
Company Name: _____________________________________________
Qualifier Name: ______________________________________________
Address: ___________________________________________________
License #:__________________________________________________
Phone and email:____________________________________________
Qualifier’s Affidavit:
KNOW ALL MEN that I _______________________ do hereby certify that my company is responsible for the (choose one)
Electric Mechanical Plumbing Roofing, on the above-mentioned permit.
I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
I, _____ (Qualifier), hereby certify that all answers to the questions in this
registration and any supplementary information attached to and made part of this registration is honest and true.
Signature of Qualifier
Typed or printed name of Qualifier
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of ____ physical presence
OR_online notarization,
this ________ day of ___________________, 20_____, by ______________________, ___ who is
personally known to me OR ____ who has produced ______________________ as identification.
(SEAL) Notary Public Signature
June 22, 2020
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Sub-Contractor--Form TO BE COMPLETED BY

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Completed 12 July 2020

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