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PERMIT# '(1 C� ISSuE QATE
0
PLAINNING & DEVELOPMENT SERVICES
'- Building & Code Compliance Division
e
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
uc�' have agreed to be
Comp. y Name/Individual Name) •§�.
the 0'' Sub-contractor for �.�. Gn 61_rzi� ',!� 1 ILA
(Ty)c of Trade) (Primary Contractor)
For the project located at JZ � r �
(Project Street Ad ress P operty Tax I #)
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.
Jain �C_(_
CONTRACTOR§IGNAT fiF(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
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PRINT!NANiF. PRii \Ai F
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COUNTY CERTIFICATION NUItiiBER COUNTY CERTIFICATiO�VN UiMBFR
State of Florida,County of y �`��� State of Florida,Count-of
The�ore,gQing instrument W215 signed before me this �day of ��or"ning instrument was signed before me tE�is� day of
bv
who is persona0y known /orhUproduceda who is personally knu„'n t�or I' produced a'
r
as identification, as identification. '
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STAMP STAMP
si signatu a ofNot ry is
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Print• the of Ne ary Public 11 Print JSamt:o Nota Pu lie
YeliftAyala ' N=YPW*also crt9"Ida
'AY COMM!--.on HH 07847t1 ® � . A
-girt E-cpiMS 001/p2 a2$07$470
Revised 11/i6;2016