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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building P& Code Compliance Division
- -- BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT MAR 2 7 2_01 7
PERMITTING
St. Lucie COUu 11.. 'L
n Q- 00�k ni [.L01 have agreed to be
(Company Name/IndivWal Name)
the ��-,odd,P, Sub-contractor for e r\l S NOL y k
(Type of Tr de) (Primary Contractor)
For the project located at Z:Jer,Sen R)QaC� �L
(Project 4treet 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.
/We'� 4eez� 7
CONTRACTOR SIGNATURE(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
/1WZGl(r a5-rni, el'SC o
PRINT NAME PRINT NAME
Y � l
COUNTY CERTIF CATION MBE COUNTY CERTIFICATION NUMBER
State of Florida,County of CATION
State of Florida,County of
The forego' g instrument was si ed before me this day of The foregoing instrument
was signed beforeme thiil r�day of
20 ,by �-, 11 I L ( -`h 20f�i,by :JarAle. (�A�C�
who is personally known_or has produced a ✓/ who is personally known Vby or has produced a
as identifications as identification.
` �C�1 —
14ASTAMP STAMP
Signature of
Notary Public �1 Signature of Notary P lic
� c State
Pitm
o1 Ftorid
ae of Notary Public Print N m L�;
Kluegel
y Commission FF 230179
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R E N S. N I E L S E N '�oxpires 08/28/2019
mission 9 FF 115637 Commission ExpiresJune 12, 2018
Revised I1/16/2016