HomeMy WebLinkAboutColin Plumb verifPERMIT # ISSUE DATE
COUN
F L 0 R 1 D A
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
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(Company Name/Individual Name
the Plumbing
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for bW VAI'-Y\41 4 �'S
(Primar ontractor)
For the project located at 9960 S Ocean Blvd. #1101, Jensen Beach, FL 34957
(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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CONTRACTOR SIGNATURE (Qualifier)
Katherine LaDeene Dodson
PRINT NAME
CBC 1250637
COUNTY CERTIFICATION NUMBER
State of Florida, County of a W G C
The foregoing instrument was signed before me this y?O day of
who is personally (mown X or has produced a
as identification.
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Revised 11/16/2016
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SLM:EOWACTOR SIGNATURE (Qualifier)
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PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of $t
The foregoing Instrument was signed before Jme this -5tk day of
. 20A by , %� I' a nn m oruk
who is personally lmown �6 or has produced a
as identification.
Signatu ol'NotaryPublic
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Print Name of Notary Public
STAMP
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