HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENT MECHANICALPERMIT # 2107-0115 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BURRING PERMIT
SUB -CONTRACTOR AGREEMENT
* H11` (1Jrk-Y1 750n in6) have agreed to be
(Company NamdIndividuitl Name)
the i/I101- ila li'll � .,1 Sub -contractor for Paul Jacquin & Sons, Inc
(Type of Trade) (Primary Contractor)
For the project located at 5701 Environment Dr, Ft Pierce, FL 34981
(Pmject 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.
,'I n A
CONTRACTOSIGNATURE (Qualifier)
Michael Jacquin
PRINT NAME
IS4(v3
COUNTY CERTIFICATION
-NUMBER
State of Florida, County of
The foregoing instrument was signed before em this`-q day of
OJOW( 20 by PV1 (�` att lA((b-tlsfl
who Is sonelly Imow fir has produced a
as identIdentification.
Y A - _ 1 fir(" AAA) STAMP
Signature ofNotary Public
`\1Ck'W le J , i�G�liS
Print Name of Notary Public
Notary Public State of Fbntla
Vakaie J Davis
�_ My Comm asi in HH 078199
Eapaea 011067025
pw
Revised 11/16/20
SUrONTRACTOR SIGNATURE(Quaiifier)
PRINT NAME
t-*a
COUNTY CERTIFICATION NUMBER
State of norlda, County of T L G! e ' QQ yk
The foregoing instrument was signed before me thisp�_ day of
%O �1Gr 20_Vby Tames -!M�
who is personally knowny—_ or has produced a
as Wen ation.
, STAMP
ignature of Notary Public
Lt_<4� AaJ-7Zlr 7P
Print Name of Notary Public li
Y'r'{( SUSAN MONTENEGRO
+ •'•.•''• my00MMISSIONHHH086964
r= EXPIRES: A012,2025
qIi' ?:
+, „,gty„,• Bonded TAm Netsry public Undennitels