HomeMy WebLinkAboutOct 14, Doc 2PERMIT #
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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
IP
BUILDING PERMIT
SUB -CONTRACTOR AGREEMIENT
ftoTF4_,,BIQir & AdrO fr-: 5 _19.yo
(ComDanv Name/Individual Name)
the
Sub -contractor for A c-oo Ili
A�5
vc��T�S�.!:
(Type of Trade) (Primary Contractor)
For the project located at
(Project Street Address or Propel
C{ K ��ty� C IVY L rZ, Z11:179 c
Tax TD yievZ 6 --- E30 0 06) -0 0 0-3
It is understood that, if there is any change of status regarding our pamcipaluon with the above mentioned
project, the Buldingiand Code Regulation Division of St. Lucie County fh VnHl be advised pursuant to the
filing of a Change ()f7 Sub -contractor notice.
( J0A000F_
CONTRACTOR SIGNATURE (Qualifier)
ND,e2F_ E 1Y1 C 14 E4F
FRdNT NAME
�O:L-N S
COUNTY CERTIFICAT141V NUWER
State of Florida, County of !Lr��e LA2Kl�
The foregoing inatwas sued before me this M�
41 dal of
�Er 2Q2pby���-.'�z�
who b personally brown .....or has produced
as�ildenliLrntion
or 1 '/
IL
C
.21 1
Print Nmuw of NoUry Pub&
Revised I I / 162016
STAMP
SIORLEY A. SAMMER
M V 0
+` 4r PL*fic. State 01 Florida
Mary
(;1Drnmj1sicm 061649
dp My Calr.rnx.%ire Jar 310 2021
10k-0 &MIded Infougn 4xilry Assn.
SUR-CONTRACYOR SIGNATURE (Qualifier)
PRINT NAME
C. A co
COUNTY CE6RTIFICA130N NUMBER �
state or modaa Caunq or !�J�QYfiYi
Sao00
The farcaIr�strt�n�nt h�ns sited bcforc me this Itay of
�1 2Q) by
who is ptrsomWly known or has produced a
as identificaflom
&JouLurD�bt Notary Public
`
rielle Paige --
Notary Public - State of Flo
nda
Com
mission # GIIIG 30
093
Expires 0_21211i��!�!'/2023
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