HomeMy WebLinkAboutsub contractor roofingPERMIT # ISSUE DATE
(Company Dame/Individual Name) e-
the«l) , ""I Sub -contractor for ye-,, � � C" 0
�e of Trade) (Pr-driary Contractor)
For the project located at
(Project Street Address or Property Tax ID #)
.3�'?1V7
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.
NTRAC OR SIGNA RE (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of of of .n L
The foregoing instrument was signed before me this 19 day of
WVAM Z, byr7/V� �
who is personally known or has produced a 6/W S 6&,) �/1
as ident' 'cation.
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Signatu a of Notary Pu li
Print Name of Notary Public
S - TRAC OR NAT (Qualifier) c
PRINT NAME
COUNTY CERTIF�.ICA,TION NUMBER
States ol�ount}, of cS`r t) IS
The foregoing instrument was signed before me this' / day of
by _ 8 /&6,),
i who is personally known or has produced a 49q;�
as iden ificat'on.
STAMP
Signature of Notary Public
Am&_,--9- Aj4, s-
Print Name of Notary Public
AMBER MARIE HUTCHINS _ �Ar AMBER MARiE HUTCHINS
Notary Public -Minnesota
My Commission Expires _Is,.31, 2022 3 Notary Public -Minnesota
Commission Expires Jan. 31, 2022
�37M►'' My p
Revised 11/16/2
STAMP