HomeMy WebLinkAboutMechSubcontract Form PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
"®�pg,�;t�l imp Building & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
14N19 SpOS Ac- have agreed to be
(Company Name/Individual Name)
the MeolAd( cZAI / AC- Sub-contractor for 94,L&a f 6v�TJWG�1�bi
(Type of Trade) �— (Primary Contractor)
For the project located at iUSON !4 fcL PAIN C
(Proiect 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
tiling of a Change of Sub-contractor notice.
CON'rRAC-)R, �l NAIRREualifier) ti1113-CONTRACTOR SIGNATURE(Qualifier)
�?Z)Qn 44 M(A C3taciL-ea
PRINT NAME: PRINT NAME
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COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of ll" r h -i State of Florida,County of�f
The foregoing instrument was signed before me this 1��Jay of The foregoing instrument was signed before me this AL_day of
lUQ rl u 4 ry ,2oal,by `foci d V4lh o r+ it 2Q�;�ed
L
who is personally known_or has produced a ,1.1 �L who is personally known a N W
as identification. as identification.
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71�..c. V l - F„"'• LOftf•'�.M�OHNS / STAMP
Signature of Notary Public M)COAIAILSSI(1�d(i(i)Ih9� ignature o Notary P lie
anW[\PIRES .lepicnther Ni.20';
Print Name of Notary Public Prfnt Name of Notary Public I
;iR�Pu'•.. :MELISSA J.SPICERNotarublic-State of FloridaRevised 11/16/2016 i�• Coission#GG 284678My Co .Expires Feb 11,2023Bonded throh National Notary Assn.