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PERMIT# 0 0('0 -On ISSUE DATE
-_ PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
0
• D
- BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name)
the Sub-contractor for
,o
(Type of Trade) (Primary Contractor)
For the project located at a\
(Project Street Address or Property Tax ID#)
31A C'\_5_1
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.
1
ONTRA R SI ATURE "er) SUB-CO RACTO SI URE Qualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of State of Florida,County of
The foregoing instrument was signed before me this��day of The foregoing instrument was signed before me this-)J day of
k- . ,to y
who is personally known('ur_has produced a who is personally know�or,has produced a
as i entification. as i entification.
AA, h STAMP STAMP
ig ature of Notary Public I S-ig6ture_o_fNotaryPnbIie
Print Name of Notary Public Print Name of Notary Public .%pRyA riana Veneziano
Quo o� NOTARY PUBLIC
Ariana Veneziano -STATE OF FLORIDA
Tsocic-
�YANOTARY PUBLICa Comm#GG185914
STATE OF FLORIDA �A'CE l9� Expires 2/14/2022
Comm#GG185914
Revised 11/16!2016 E VI Expires 2/14/2022
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