HomeMy WebLinkAboutSub Contractor Agreement Permit SLC 2110-0222PERMIT# ��C ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
jA)'C/'r C 4�1-;C- , In C. A) 4t It I 1 1-1 J�U'b&r
have agreed to be
Company Name/Individual Name) �v
the 1-.e e � v c Sub -contractor for (?I, o ►')'1 U 1 �-� �-► -0 ` S
(Type of Trade) (Primary Contractor) G
For the project located at ` 71 9 -7 S. Uf Af I J.�2l<l Sa / '1,f60 -Jv, J0 /9
(Project 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.
CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this day of
. 20____, by _
who is personally known _or has produced a
S CONTRA OR SIGNATURE (Qualifier)
'TRINT NAME
Jo0> /
COUNTY CERTIFICATIONNNUMBER
State of Florida, County oflC "�" tl-C -4_
The foregoing instrument was signed
d before me this�1" yof
who is personally known t`�has produced a
as identification. as identification.
STAMP -� A ` , -
Signature of Notary Public Signature of N " ry Public
!.
Print Name of Notary Public - Print Name 4fNotary Public
Notwy of Florida
Revised I I/]b/201b G 330259
YEE
STAMP