HomeMy WebLinkAboutHIRSCH SUB CONTRACTOR ELECTRICPERMIT # ISSUE DATE
IV
COUNTY
F
L
O R
I D A
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
CA- (jam, %'f have agreed to be
(Company Name/Individual Name)
the �-LEe T,Q / e Sub -contractor for zyzf"_-
(Type of Trade) (Primary Contractor)
For the project located at _" p/yzz-
(Project Street Address or Property Tax I D #) /= G 3
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.
l
CONTRIACIR SIGN
l E (Qualifier)
IIFYI14AI
1`/ 4f�; IWXAI
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of�T//J
The foregoing instrument was signed before
me this 9 day of
24A byy A')W
who imp uuallF 14 or has produced a
as identification.
--��//�! 'TAMP
Signature of>6tary Public
D/P
Print Name of NoUrti l'uhlic
Y FrNrtary Public hats of Florida
e Lori A Moxiey
a nay Commission GG 280148
d 'oa M1 Expires 11/2812022
Revised 11/16/2016
SUB -CO .4 SIGNATURE (Qualifier)
lei'CA z5 1�'eXelb�e/ c
PRINT NAME
EG 0
COUNTY CERTIFICATION NUMBER
State of Florida, County of 1,12
The foregoing instrument was signed before
,meTthis 9day of
20� /by /�/ CC
who is_@ersbn• or has produced a
as identification.
G! • ���fi' STAMP
Signature of otary Public
Print Name of Notary Public
o,�A'r q'+; Notary Public State of Florida
6 Lori A Mioxloy
My Commission GG 280146
Expirea 11128/2022
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