HomeMy WebLinkAboutSubcontractor agreement, elec PERMIT# 0—DI-4 d ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
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BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT RE�EI! p
All y
125 7 444_6�� /-- l et4p4CCtL ��Gz tJ�� have agreed to be
(Con any Namedndivi ual Name)
the /e e �oe(cG, ( Sub-contractor for 1-441e z:: �
(Type of Trade) / /� rimary Co ractor)
For the project located at jc 3 e 7y-�e S Ia.-�; ,J k 1
(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.
CONTRACTOR SIGNATURE(Qualifier) 2 9UB-CONTRACTOR SI ATURE(Qu er)
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PRINT NAME PREWNAME
i Gi✓LltE' G 1
G 13 00�a5
aR(050 :2,X LLi,
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of C e State of Florida,County of Cs �.(Jua t-e
The foregoing instrument was signed before me this 0�V day of The foregoing instrument was signed before me this day of
2011by,5C C3--1- Pe—+-7Z.. zo_( ,by f W t C VVW-I A r,�V-,c3 tom, �
who is personally known or has produced a FJ_.WtJCr UC;CrrQ who is personally known or has produced a
as identification. as identification.
0 W STAMP (,�..CJ�—l/'l_ STAMP
Signature of Notary Public Signature of Notary Public
Print Name of Notary Public Print Name of Notary Public
NICOLE ORTADO
&4VCEIS1
NOTARY PUBLICGARLICNELSONSTATE OF FLORIDA :�:° Notary Public-State of FloridRevised 11/16/2016 Comm#FF180038 s l Commisflon�►FFti6S59S
. Expires 12/1/2018 ;, �Y� My Comm.Eiipirn ft 21,ZOZO