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PERMIT# ISSUE DATE
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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
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- - - -- BUILDING PERMIT —�—
SUB-CONTRACTOR AGREEMENT RECEIVED
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JUN 2 9 2018
ST, Lucie County, Permitting
y have agreed to be
(Compan Name/Individual Name)
thel �C� L- Sub-contractor for Oil WelyQ
(Type of Trade) (Primary Contr ctor)
For the project located at I (e 05 c nam`( _:� h/t -fv- c-"F 3'41 Li1'S
(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.
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CONTRA' OR SIGNATURE(Qualifier) UB CONTRACTOR SIGNATURE(Qualifier)
PRINT NAME PRINT NAME
! ���e� 71o�cleel?_
COUNTY CER ICATION - /,BE`/R� r CouNTY CERTIFIC TI9NNUMBEAL/
State of Florida,County of�1�J- 1G State of Florida,County of�Clti
The foregoing instrument was sign eforepme thisw
y of The foregoing instrument was signed be
e� :`-me this day o
mc %to
who is personally known_or has produced a L who is personally known_or has produced a: L L
as identification.' as identificati9n.
STAMP STAMP
SignatuTe of ITotirry 4P. 1ic Signature of Notary Public
''� IV S. NIEI.SEN
Print Name of Notary Public ? State of Florida-Notary PUblic I Print Name of Notary Public
Commission # GG 207484
�i"0'f `���� My Commission Expires
'� ` June 12, 2022
KQf3FJV S
S
"_. a*' rate of Floors NIF( SE blic
F Pic` Commisci da-Notary p
iiii�` My Corn #G" 207484
Revised 11/16/2016 Juhm72 7D22Pires
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