HomeMy WebLinkAboutElectric Sub PERMIT# �� �� ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
iCOUNTY
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
-S_e'_✓< <t 3: L have agreed to be
(Company Name/Individual Name)
the C )e c �+(-j'C 4 If Sub-contractor for Wt l ce, ✓<.� t vv►
(Type of Trade) (Primary Contractor)
For the project located at J 0�0 •0 CQfl DY U�- U12,
(Project Street Address or Property Tax ED#)
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 SIGNATURE(Qualifier) SUB-CO CTOR SIGNATURE(Qualifier)
R �J I ) I lam_S -T� i..'"
PRINT NAME PRINT NAME
24? y 4:1 �2_ -7
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of State of Florida,County of
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this 1z day of
20bI by R, W 11 11aff)'s -7b �/A y _
who is personally known for has produced a who is personally known�or has produced a
as identification. as identification.
h��a4z_4�� STAMP STAMP
Sig re of Notary Public SigkstpWof Notary Public
Dt kn ` f)t: A
Print Name of Notary Public Print Name of Notary Public
DANM FMGERALD
MY COMMISSION#FF 0M29
EXPIRES:DKemher �._01� wtis DANA WILLIAMS
I gpnded 7hru Notary Public llndzrwr terc
rnz
MY COMMISSION#FF078903
... EXPIRES December 25,2017
Revised 11/16/2016o`a"�
(407)3gB-0153 Fl0[idaNOtaryServlce.COm