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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
"` - Building & Code Compliance Division
110
- ----- - - — BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
have agreed to be
(Co pany NamelIndividual Name)
the Sub-contractor for � ) —
(Type of Tra (Primary fContractgr
L 9�^
For the project located ate S N -7
(Project Street Ad re s 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.
C07RACT R S ATURE(Quali ) -CONTRA / R SIGNATURE(Qua r)
PRINT NAME PRINT NAME
N1 A N/A -
CO NTY CERTIFICATION 7COYNTY CERTIFICATION E
State of Florida,County o5�4 State of Florida,County o
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this / day of
2n1 by D ,20L7 y ¢.
who i ersonally known_ r as pr duo a „P,C who is p rsonally known or s pro a
as identification. as identification.
STAMP MP
Sig ature of No a bli Sig ture of Notary P 1'
Print Name of Nota Public / Print Name of Notary Publi
//J
AUDP,FY B.H!lh-iPHREY
•:�PPY'"o AUDREY B.HUMPHREY ,, , ..
MY COMMISSION#FF 174772 :, +?` ,.' *" MY COi✓r.15�1CJI I#FF 174772
' ` EXPIRES iularch B,2019
EXPIRES:March 6,2019 hh °"� '"
Revised 11/16/2016 +oe ;p' BondedThruNotaryPublicUnderwrters
o;' Bonded Thru Notary Public Underr+riters