HomeMy WebLinkAboutBysshe Sub AgreementPERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
i
s • -
- - — BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
W i r e � u t n L have agreed to be
(Company Name/Individual Name) g,�,-�
the (� C f i Cc� Sub -contractor for /�'/Q%T ��"/� l�A (. 1 i,
(Type of Trade) (Primary Contractor)
For the project located at
ect 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.
COi T ACTOR SIGNATURE (Qualifier)
Fedo-i ck W1
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of -S� e
The foregoing instrument was signed before me this QU day of
- � ' 20" by
is known ✓e or has a
who personally produced
as identification.
atur o Notary Public
L�09:
'•,ol; ?:a
r� 1-d-ncrn
o
.
Print Name of Notary Public
z U 1 N
C l7
Z
? 0
if
N G%
N N
Revised II/16i2016it
4'
;3
C_ PJr_
SUB -CONTRACTOR SIGN+ URE (Qualifier)
�<<L
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of - L v (' L
The forgoing instrument was signed before me this ZQ! day of
ho is personally know or has produced a
as identification.
�-IC�Ns �I�'gG
L
yL�+lCrl�I.i�
Signature of Notary Public
7 A.
WOUI4 /
IT, p
.2
Print Name of Notary Public
N 3 r-
03 c�v
N
O O
N _N
7 CD
N n`G N
O
Q1 .n
T U