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PERMIT # ISSUE DATE
(Type
For the project located at
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT -
SUB -CONTRACTOR AGREEMENT
D� nU(r• have agreed to be
for l 7 ZVQ-v-c- I Y 1 P ate` -
(Primary Contractor) �,_,,Wr'5Lak_Y
i51 cJ �'t1t:= r.
(Project Street Address or Property Tax ID 4)
"60, ' ODD, l
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)
C blzi Ro Mciy
PRINT NAME '
COUNTY CERTIFICATION NUMBER
5 State of Florida, County of � e
The foregoing instrument was signed before me
this,O�C! day of
who is personally known _or has produced a �.�(� JtYS (jGBYItX.
as identification.
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Revised 11/16/2016
CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
#RID41iq
COUNTY CERTIFICATION NUMBER
'!
State of Florida, County o0_LL___tk_ Lam(
The foregoing instruments was signed before me thid sc dayof
,20( 1/by �a.rt-Ti�s 5A4det.
who is'persoaailj known=Or has produced a
as
SABRINA L. BLACK
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