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PERMIT# ISSUE DATE L, -
Y PLANNING-& DEVELOPMENT SERVICES 1,
Building & Code Compliance Division
- - -- -- BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
•I.
a. ihave agreed to be
(Company Name/Individual Name)
the j=-( �—�CCL ° ' Sub-contractor for
(Type of Trade) 9 (Primary Contractor) f!
For"the project located at
(Project Street Address or Property Tax ID#11 1
i`
It is understood-that, if;there is any change of status regarding our participation wltl ',the above mentioned
project, the Building and Code-Regulation Division of St.Lucie County will,,be advised pursuant to the
filing of a;Change of Sub-contractor notice. `
4
CONTRACTOR SIGNATURE(Qualifier) -SUB i RSI ATUR);(Qu'ilifier)
:y
PRINT NAME- PRINT NAME
13 aC7'1z.7S f
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER f
State of Florida,County of Stale of Floriiln,County of�`. �,(Gl
l !'!j k
The foregoing;instrument"was signed before me this day of The fo going instrument was signed before me this�day of
j
by ,20L,by
wiio is Personally known_or has produced a who is personally known_or has.produeed a
as identification. asTAMP .dentificntion: j!.
r
SSTAMP
Signature of.Notary Public Si n ture otary Public j,'
i
Print Name of Notary Public Print Name of otary�;
JAYME'CHAVEZ.
MY COMMISSION#FF991925
Revised 11/16/2016 EXPIRES May 12;2020
(407)398.0153 F.Iofldallo samce.com'