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PERMIT# o` I ISSUE DATE
L/ t
PLANNING & DEVELOPMENT SERVICES
Building& Code Compliance Division
•
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
t b w yl mow L 't C 17iM cS have agreed to be
(Company Name/Individual Name) ._r_ , - I B
the 01 u Vrb tt� C `YISy*16A Sub-contractor for I
('1ype of Trade) //�� A 11 11 � �(P�rimtary Contractor)^v 2
For the project located at �e'ab 1\I VJ� `u, , eller"e
(Proje d Street A dress 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
Svp filing of a Change of Sub-contractor notice.
SIGNA (Quatlaer SUB-CONTRACTOR SIGNATURE(Qualifier)
PRINT NAME � l'1
ate td3 Q °�n5�
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of /` State of Florida,County of s I. W'cie— 2(](�
The foregoing imtrumene was signed before me thssA do of The foregoing instrument was signed before thisv 'day of
20]Fby ,20�by In
who is personally known or W Produced a who is penomlty Iwo"iar has produced a
asidentification. dntfti
STAMP W 0( STAMP
Signatu� ubfc Sig re of Notary Public
Priot Name of Notary Public V Print Name of Notary Public
?oy;; ,,, ELLEN VAUGHN
State of Florida-Notary Public ,rav Notary Putoc State of Fionda
Commission t1 GG 270079 $ AN Julie Baird
'? � My Commission Expires My Commission GG 2a18at
������" October 22, 2022 Expires 12/05i2022
Revised I1/I '"- a*
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