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ST. LUCIE COUNTY PUBLIC WORKs
BUILDING & ZONING DEPARTMENT
BUILDING PERMIT
SUB-CONTRACTORAGREDDNT
· St. Lucie ~ty COQtractor Certification Nutober:
State ofFJorida CertificatioD NUIJJber (JfaPÞ1ic:ab1e):
jìf.}^5~r f}}L 5Q..~/..-/¿{>
(Company Namcllodividua) Name)
qful
LA-CØOqj'(,(p
have agreed to be the
Hv~c....
(TyPe ofTnade)
sub-contractor for S L 1"'\ -t r~ {¿ ~lD IV') ~ 5 ~ r é
(Prirna1y Coutractor)
· for the project located at 5 S- 0 J ,~ IY\. ~ r S co '"} /::j l.- P
, (Project Stnet Address or Property Tax ~ #)
It is understood that:. if there is any change of status regarding our participation with the
~bove mentioned project:p ] will immediately advise the ByiJdjng and Zoning Department
of St. Lucie County b~ perSDna)]y filing a Change of Contractor notice. (Form: 'SLCCDV
N'o_ 004-00)
BUSINESS QUALIFIER (NabJc of the Individual shown OQ the Contractor's License)
ORIGIN L SIGNATIlRES ARE UfREn
~'H~
GNATtJRe
-r ~c""'.... 5 Q, ~ 5 c r
PRINT NAME
úl-¿c-¡ Ie")
DATE
Business Name:
Address:
City/S1ate/Zip:
PbODC:
¡¿0\^'5~ r {*I(. 5~ r-v.'c:..~ .' f\. c..
q 8'<-\,5 S E =-,,A J-I \Iv 'i
1-1 cb'\ £v,,01 F- J S.? £.\55
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OFFICE USE ONLY:
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PERMIT " ISSUE OÞ,TE
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