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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
z - Building & Code Compliance Division
•
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name)
the Ks 2A vrr6,, Sub-contractor for
(Type of Tra e) (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 pursuant to the
filing of a Change of Sub-contractor notice.
CpOR SIG A E(Qualifier) SU ONTRACTOR SIGNA RE(Qualifier)
PRINT NAME PRINT NAME
CSL' o������ CCC 9
COUNTY CERTIFICATION COUNTY CERTIFICATION NUMBER
State of Florida,County of 4' t / e- State of Florida,County of ^e
foregoing instrument was signed before me this vj I day of T oregoing instrument was signed before me this 1)11 day of/
20L7 by �� .i/ J 20L,by
643 p rally known_or has produced e J is perso Ily known_or has produced a
as identification. as identification.
TAMP r /�✓�STAMP
Signature of Nota ublic Signa re of Notary Pub c
--P �' }, r u o � �
Print Name of No Public Print Name of Notaryiu c
AUDREYB.HUMPHREY -- —I.
' MY COMMISSION 0 FF 174712 �;Y'> AUDREY B.HUMPHREY
*' EXPIRES:March 6,2019
t: MY COMh11SSI0N p FF 174772
Bonded Thru Notary Public Underwriters °�' = EXPIRES:March 6,2019
Revised 11/16/2016 RF"' ';E;4 Bonded ThruNotary Public UndaI*'hers