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PLEANNING & MEVELUPWIWENT SER CES
Ufldlug & COde COM,04nee i ? Aids o
MU—M WN, G ?E vU g
-CO IN C a OR AGI'.EEVM I-�
(Cornpa€iy Na-,ne(Indi-.3idual Name}
the!k
tiylea> Trade} Sub -contractor for
(Mmar}r Contractor)
Par the �iroject Iocated at � � �L� � � ; -
Wroject Street Address or P€-ope my Tax M r—
have ac eed -to be
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it is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation .Divisio.n of St. Lucie County will be advised pursuaut to the
COUNTY CERTITICATIGN NNFT�jB R
State of Fl€ vida, Couu- of k{'{_
TIse foregoi35 iustrument-as signed before me this day of
201a kv
irho is persoaaBy imown/--or has produced a
as identification.
U
Sig ure of rtotare Public
J�plw
?rint Name ofllotar3• Public JENN
�w augt�
_° .• ' • ° Commission #4y 29 32p23
* * ExpisesAp
�fT OFfLApo BondedjWBUd(j0W11arySo'u`G
Revised 11/1612016
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COUNTY CERTIFICATION ik-uIMBER
State of Florida. Couutr of }}
The forc niay i0strnment %vas signed before me this (� day of
ss hcs is p . sonailp o s, �or has produced a
as ide "Ji ion.
STAMPr lunobt
STAMP
5ibnarure ofiNotary Public
ni
Print Name of ?4otnry Public
DANIELLE ZIELINSKI
:�" Commission#GG918121
f : *:
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.;;s Expires October 13, 2623 ].7019''-kBOOMThmTroyFai,wurenca8£�Q