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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
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BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
v
have agreed to be
(Company ane/Individual Name)
the Sub-contractor for
(Type o Tae) (Primary Contractor)
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For the project located at
( roject Street dress or Pro erty 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.
/I
CONTRACTOR SIGNATURE( ualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of a"SL State of Florida,County of
The foregoing instrument was signed before me this:M day of The foregoing instrument was signed before me this day of
201?by .2q_,by
who is personally knowor has produced a who is personally known or has produced a
d.tuti9oSfN.t.ryfication. as identification.
STAMP STAMP
Public � Signature of Notary Public
Print Name of Notary Pubtic Print Name of Notary Public
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Revised 11/16/2016