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INDIAN RIVER COUNTY/CITY OF VERO BEACH <br />BUILDING DIVISION <br />1801 271h Street, Vero Beach, FL 32960 772- 226-1260 <br />INDIAN RIVER COUNTY/CITY OF VERO BEACH <br />PRIME CONTRACTOR AGREEMENT/AFFIDAVIT <br />Indian River County Contractor Certificate Number: <br />State of Florida Certification Number (if applicable): <br />Permit Number: <br />will be conducting the work for the following trades: <br />(Company/Individual name) <br />❑ concrete ❑ stucco ❑ electric ❑ aluminum (in -fill only) ❑ other <br />❑ masonry ❑ insulation ❑ mechanical ❑ garage door <br />❑ carpentry ❑ roofing* ❑ irrigation ❑ fuel gas (lines only) <br />❑ drywall ❑ plumbing ❑ burglar alarm/low voltage <br />It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately <br />advise the Indian River County Building Division by personally filing a Change of Contractor. <br />*Roof coverings other than asphalt shingles, wood shingles or wood shakes require a licensed roofing contractor. <br />PRIME CONTRACTOR QUALIFIER <br />Signature: <br />Printed Name: <br />Date: <br />STATE OF FLORIDA, COUNTY OF <br />Sworn to and subscribed before me <br />by <br />Type of ID produced <br />Printed Name of Notary <br />Signature of Notary _ <br />Notary Seal <br />day of 20 <br />who is ❑ personally known or ❑ produced identification <br />Page 5 of 9 <br />