HomeMy WebLinkAboutSubcontractor Agreement PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
COUNTY Building & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
i(1R have agreed to be
Company Name/Individual Name)
.the N`r1 Sub-contractor for ,J (Ads 4_QAg,11CLL
(Type of Trade)V
,(Primary Contractor)
For the project located at hJ-
(Project Street Address or Propert3A 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.
CONTRACTOR SIGNATURE(Qualifier) SUB-CONTRACTO,SIGNM ii ualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER y� �/ COUNTY CERTIFICATION NU^M/BER
State of Florida,County of � 'Q 1AA1 State of Florida,County of �l' 'y'- /(?/ �2
The foregoing instrument was signed before me this-6 day oof The foregoing instrument was signed before me.thisJ" /day,ofn
f ,20 by U�(C( VV&(T �it LA ,20 '�by
/i
who is personalty known /or'has produced a _ who is personally known vor has prod ced'a
ai identification./ as identification.
�,� .+..• - <F/jej- %' it
STIVNIP- .ve�jlja'�j-J Tn1Vf9'
Signature of No P b c = j - Signa ure o of ublic F --
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LIM) AVA)
Print Name of No ry Public Print Name of tary Public
Ey,, Notary Public State of FloridaRevised 11/162016 K Mary Ann Kalin% My Commission GG 1031tI4M1 Expirest24/2612022