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PERMIT # 1 �� _ a� ISSUE DATE
COUNTY
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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
_ have agreed to be
(C tnpapy Na
meClndividual Name)
the Sub -contractor for 6)03
(T a of Trade) (Prima ontractQor��►�"J))
For the project located at "1 tob0 5 '�J'�-a-�r 1 �,'I * D0a'' �1 C", !i"
(Project Street Address or Property Tax ID #) B q, 5
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.
LAlloulu-,k�76
CONTRA .TOR SIGNATURE (QuallSer)
PRINT NAME
Chc, l le'20 U3;J
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing Instrument was signed before me this I day of GG
J Ulf 20Uby K. LQ ecat 0&0.q
who is personally known %for has produced a
as identification.
{ 5 'AMP
Sig tune of No ary Publlc ¢
Atho L. gal
Print Nandf Notary Public c
Revised 11/16/2016
124
SIGNATURE (Quallfler)
a,l t +V&W m uv� aL
PRINT NAME
&R, IA'Z616
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before m(e�this T�y-of J
J 0 20 2l, by �/ L 1', �i Lr~ 0 �GL
who is personally (mown X__or has produced a
as identification.
J-_—,
Signature of Notary Public
S&Aq M. Ti-QLL;,AL
Print Nan& Notary Public
STAMP
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