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PERMIT # ISSUE DATE `
�,OU,NTY
k 'L 'O: K I D A:
I IMF
For Him Plum
PLANNING & DEVELOPMENT, S084CES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name)
the plumbing Sub -contractor for ,gler Kitchen Bath, & Floors, Inc
_.
(Type of Trade) (Primary Contractor)
For the project located at 4511-514-0009-000-2 / 10410 S Ocean Dr #209 Jensen Beach, FL 34957
(Project Street", ddress 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 pursuant to the
filing of a Change of Sub -contractor notice.
CONTRACTOR SIGNATURE (Qualifier) SUB -CONTRACTOR SIGNATURE (Qualifier)
K. LaDeene. Dodson
PRINT NAME "
CBC 1250637
COUNTY CERTIFICATION NUMBER `
State of Florida, County of Martin
The foregoing instrument was signed before me this � day of
by
who is personally known or has produced a
as Identification.
Signature of Notary MIN'
Print Nameif Notary Public
Revised 11/16/2016
Dale Hammond
PRINT NAME
COUNTYCERTIFICATION NUMBER '
State of Florida, County of. Marten
The foregoing Instrument was signed before me this da y of
who Is personally Imown ,pr has produced a
o+ as Identification.
TAMI' :. S ANYF'
. � SJgnatt�r+r of i�aiary� Publtg .
�
�
w� '., Priut NaM n Notary Public