HomeMy WebLinkAboutSubcontractor (2) PEiZittlT ! ISSUE DATE
A,x ;L a i CodeCo ��Div Wan a FAUG
CETV6D
HIM. ��� ��� IyUMD MG���M� 2 4.2021unty, Permitting.
Cis z t,xr ti:n t :.ct c t n c; bave agreed to bt:
(CAmpany Name?Iudividual N;im:)
tlle.: � 'i.� Sub-contractor for ( �� vv-e AK
(Type of Trade,) . 11(priimaryr Contractor) /}
For ih&prq?ecl located at. ( o l i1.7` !:`tf�4�' ►7 f�i 0
(Project Street Address or H operty t ax ID r)
It is understood that,if there is anychange of status regarding our participation cVitl!'tlte aboi a mentioned
project,.the Building and Code RZegulation Division of St Lucie County=will be advised pursuant to the
filing of Change of Sub-contractor notice.
TRACTORSIC,N t;t2E(Qual(rier) Sill-CONT30 CTORSFGY<+TURE(Qaatifler)
PR(,d1''.NAlOW PRINT NAME
COUNTY.Cr.RTIPIC Vrtbti NU.NIMR COUNTY CERTIFICATION NUMBER
State of Flta'ida,Couiu)•or �re,&i _ State of FIarid_.£ounty of 0 Ag2
The fercgaing Gistramtut srac siqued before tote Ws J O dam of The tore;einr iaStrunicnt era`s st�gned�bbeeffore we this (O day of
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ettts is flersoAallf I2nown has produced a who is persouallc Icuovu or has produced a jdjv 11 r-(AA.
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'gnpturClnf',otary PubUc SignatuDWiNatury.PubUt
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Print dame ar3Hotary PuhIk Prtut Name o€Antzrg•Publicl }
4gYP�e LINAMARIAGOMQ o� �P�o t6dAMARIAGOMEZ'
r° ,4o z +``� Commission#HH 676897
Commisston6HH 076897 l
Expires January 4,2025 oeo� Expires January 4,2025 %
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