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PERMIT# O J ,;q ISSUE DATE II
11
n �� . PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
W41412
e e BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT,
have agreed to be
(�Cjompany Name/Individual Name) 11--
the Sub-contractor for D, I,(
(Type of Trade) (Primary Contractor)
For the project located at
(Project Street Address or Property Tax ID##)
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 pursiiant to the
filing of a Change of Sub-contractor notice.
C0NTRACTbR SIGNATURE(Qualifiler)) SUB-CONTRACTOR SIGNATURE(Qualifier)
,
PRINT NAME PRINT NAME
LI 3 c?�-) ��'!� )'-�2�>'
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMIBER
State of Florida,County of S — State of Florida,County of S+ 'L
The foregoing instrument was signed before me this j dray of The foregoing instrument was signed beforeme this 'day of
t. ,20'_,bY 1 �t�`/ t�yl 1C�C N�",(t ,20 a ) 11411� �^
who is personally known or has produced a [ ! )t who is Jpersonally known V.I.1/ has produced a
as identification. ` as identification.
W STAMP A ���
STAMP
Signature of Notary c —Signature of Notary Public
EC V �vr / 6-2,111)IV7
Print Name o Print Name of Notary Public
�ap�'pG' EL�E
`Stat N VAUGHN
e of Florida-
-� Commission #Notary Public GERILCALHOUN
270079
My Commission Expires i�' Notary Public-State of Florida
lllll\\\�
October2p 2g22 -or
/. My Comm.Expires Oct b.2023
"'^^" national Notary Assn.
Revised 11/16/2016 Bonded