HomeMy WebLinkAboutSub PERMIT# ISSUE DATE
�. PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
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BUILDING PERMIT j
SUB-CONTRACTOR AGREEMENT
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�2�1,,�ei-Har l tc��tc. C o r�punv have agreed to be
(Company Name/Individual Name)
the C_JedrrJCc�J Sub-contractor for (;)MVJC_ Lovtsfryed�6^
(Type of Trade) (Primary Contractor)
For the project located at `3 40 q -W —bd01 — 030—I Dave S�•
(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.
I
'O RACTOR SIGNATURE(Qualifier) SU ONTRACTOR SIGNATURE(Qualifier)
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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 cMday of ,^e The foregoing instrument was signed before me this 3� day of
~ U y C� _J"- ,20 n by '� � A
who is personally known r has produced a who is personally known or has produced a
entification. ntificapon.
-- CIA\,- STiAMP
Signatur tary Public Signature of Notar li
e of
P is ar u ie Print Name of Notary Public
pRV pG9•i \
Notary`Publ c-LA M.HUFF
"9° •a Commiss)o State of Florida
MY COMM. n#FF pggl30 :'
Bonded Expires MaY 27 Yb' DAVID JURKIEWICZ
throe ?l t3 :i�~tR ` ,;
'Revised 1I/16 0 ' BhNationalAlotaryq�S� 3= MY COMMISSION#FF998909
EXPIRES June 05,2020
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