HomeMy WebLinkAboutsub contractor PERMIT# ISSUE DATE
-Yt? — 071
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
COUNTY
F 1 0 R I D
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
have agreed to be
(Company Name"IndiAdual Name)
the C L pPA3R [a r Sub-contractor for ALL_ _C
(Type of Trade) (Primary Contract6
For the project located at __A9 q 7- ,X; OW 'W Le_.,,!T4 A?Yu t-FLIU75-1
(Project Street Address or Property Tax ID 4)
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.
CON"TRACTOR SIGNATL RE tQ t r1 sL'ii_coN'rKk('T0R S GNATURE(QuJir"r)
PRINTNAME P9TNT NAAM
C01"N'T —
� CERTIFW A C 13,;?TioN,N1",ViBFR COUNTY CEO ERTIFICATIO JIS -a C)a I _4...........................................
Y N NUMBER
State of Florida,County fl,Y t State of Florida.County of—_.._.
The foregoing instrument was sign�t before me thiC& dy of The foregoing instrument was signed before me this &day of
.2Q7t,by&)l �4—
who is personally known_k..._or his produced a who is personally known or has produced a.......................
as identification. as identification.
STAMP STANIP
ignal4uro(rotary Public Si aatur of rotary Public
ALia ILL 611(13ilvo
Prtdt Name of Notary Public 'of� N' �ry Diublic
DEBORAHLAILISTIN
DEBORAHLAUSTIN
Commission#GG 165611155 Commission#GG 1656V,
Expires January 6,2022
Expires January 6,2022
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lai� Thru Trcy Fa�r Insurance 800-3
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