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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
•
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
I
/- ( /TJa64/"G� have agreed to be
(Company Name/Individual Name)
the �i �, i , Sub-contractor for r^0
(Type of Trade) (Primary Contractor)
For the project located at 2f �l6 �� r�1' C�� �� PClC� 7
(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
//SI NATURE(Qualifier) SUB-CONTRACTOR S GNATURE(Qualifier)
'PRINT NAME PRINT NAME
&/[k/ 7
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER State of Florida,County of �uc State of Florida,County of--(�'�Ir��
�
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The foregoing instrument was signed before me this ay of The foregoing instrument was signed before me this day of
who is personally known or has produced a who is personally known or has produced a uw
as identification. as identification.
EAKA K A/ STAMP 1 �f A I(11 - �= STAMP
Signature of Notary Public Signature Public U
tA�12 r \]'('kI'Al2
Print Name of rotary Public Print Name of No Try Public
ELLEN VAUGHN
i �cState of Florida-Notary Public W.,
ELLEN VAUGHN
Commission # GG 270079 �_ -State of Florida-Noary Public
on # GG 270079
My Commission Expires Commissi'Ot ctober 22. 2022 '��i OFF��,,l�� V Commission �
� . ssion Expires
Revised 11/16/2016 2022