HomeMy WebLinkAboutProject Information PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
• EIVEQ ing & Code Compliance Division
LW1 ------- _._.... w...... BUILDING PERMIT
I
B r_ 3 S B-CONTRACTOR AGREEMENT
ST. Lucie County, Permitting
nff'o- 7�fn't(:��no r-)not 10 160 AGI f have agreed to be
(Comp ny Name/Individual Name)
the Sub-con actor for
(T e of Tra (Primary Contractor
For the project located at s/ A)Q f_" J)Qj a l e
(Project Street Address or Pro Tax ID#)
It is understood that, if there is any change of status regarding our participation with 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.
NTRACT_/ISKINXTURE( a ier) B-CONT R SIGNAT Qualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of i State of Florida,County of-.IV
The foregoing instrument wa by-
,
before me this 1J day of The foregoing instrument was si_7j_
gneedd before me this day of
20 by 1 L& f el 2018 by // M ff 4�1 p70
who is personally known Y(—or has produced a who is personally known ✓or has produced a
as ideor4ation. 'Sign
den' ;otary
n.
STAMP STAMP
Si a otary Public ure o ubGc
I
Print N"me f Notary Public P 'nt ►me of Notary Public
RYAN LYNN COLLUPY
RYAN LYNN COLLUPY
MY COMMISSION#FF170227 _ s MY COMMISSfON 3FF170227
EXPIRES October 21,2018 s IT.. XPIfE_S Oci�:Der 21.2018
E
.......... ''•:'For F.Q.
Revised 11/16/2016 (407)398-0153 FlondallotaryService.eortl
(407)398-0153 Flol--- -r;tty$ernce.co