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PERMIT 11 I{ ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUIi.,DING PERMIT
SUB -CONTRACTOR AGREEMENT
Y»uu + < ---__-__---have agreed to be
(Company NhAeffindividual Name)
the. 1P.r4q';CJ:k Sub -contractor for GX Per- Chu er' r ;& nr. .
(Type of Trade) (Prinidry Contractor)
For the project located at ( 089 G M+.+i rS�1�4� r1, x 349&(o
(Project Street Addresser 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.
CONTRACTOR SIGNATURE (Qataimor)
f 01
1 NNAAME 7 —`
COY.1.,.,L ✓ ___.
COUNTY CBRTIETCATIUnN NUMBER. _. _._..-.__._7_._._._
State of Florida. County of . L iwk,
T fervVeing in3tnitaealt was sigo6d befotfe me tNa day of
' 'f 20Abl
'Abu is personally knewa )Por has produced a _
as idenfificattQn.
STAMP
Signature of Notuy Public
1
Print Ram o Nolary PttbHc
$r,
Taylor O'Brien
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG958999
R"""'' "/'�,znu' Expires 2I17I2024
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SUB -CONTRACTOR SIGNATURES (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, county of- 5+.144- c I td
The feregotog iastrument was signed: Uteri'ern the this 144. day of
lbY hrgVt
i___
who is personally known Xor leas produced a
ax idenlificatiun.
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Print Name of Notary Public
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