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PERMIT#, ISSUE'=DATE
PLANNING&DEVELOPMENT SERVICES
- - Rnikling&Code Compliance Division
stRn»PERNIrr
SLAB-CONTIfACTOR AG MEIVT
1 t ,- t.ici - f r c n a ; I>n: . __:. ,7 "L 4r'i7da.0.fir have agreed to be
-- (CouTany Nw=/I"viduat Name)
the_.�_..f-lecr&L _�_ Sub-contractor for
{Type of Trade) {Prsrnary Cotnraptorl
For the project located at i� N e !„c , , F-r., +
(Project Street Address or Fropert}4 Tax ID 4)
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 SL Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
VIA 4�
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FRMNAME PRft?NAW
C?> 02 k c
CGUIN Y CERTIFICATION NUMBER * COUN Y CE;RTIKCATIQN NUMBER
Stale of FUAda,Coady*( State Gf Fk tic k Comfy at S11 LQ Li 4e
'tire fereEaing to eat was Aped before aoe thk;Q rp,day of T k--fsrnw t Isorameat wn s%ned�before me tads r dry of tt
W he
WW Is perssaaley ewa or kas produced a wYe iu petssaafly leaowro�or iarf prodared a
at as• \�\] as id+ readoa.
U � .� -�+ tiT11IP <� � �� Kd`��i2.(C STAIiP
;signature of N+nary Public lgoatscrc ret# Pal�fk
I
Print Na rlotury PaMSr filet Name of NoGry P"bIk
NOTARY PLft C ,Myti/LAN�.
SPATE OF FLORIDA Na q Punic Stale d floral
{Cwr#* 3Gwgw Rard0ph McDsniR1
IR,�tZOG'0 t1y ► �x s 6510712 3S22SS
Revised i 1/16P101b ,