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PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
6em-lbolvc, I have agreed to be
(Company Name/Individual Name) V /
the > Loc_ -Ri GA L Sub -contractor for S� lleN /V ° / A
(Type of Trade) (Primary Contractor)
For the project located at 190/o IW I L UAA
(Project Street Address or
plegcd
Tax ID #)
3 t982-
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.
W
CONTRACTOR SIGNATURE, (Qualif r)
'E�t'a_ V e__
PRINT NAME
COUNTY CERTIFICATION
NUMBEIZ
State of Florida, County ofC//e�k%/���
The foregoing instrument was signed before me this �8 day of
OG7WOEW 20,;!Ay
who is personally known V`or has produced a
ntification.
STAMP
Signatur f Notary Public
�rr+r
AIR Pi' MARIOA.GOMEZ
..; gIMW@ORtMION # GG 153722
ate= EXPIRES:November4,2021
Bmded ThN Notuy Public UndOWdm
SUE -CONTRACTOR SIGNATURE (Qualifier)
EBWARD W. AIRS
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of BROW
The foregoing instrument was signed before me this 19 day of
OCTOSER Zo 2 by EBWAPD W. AIRS
who is personally ]mown A or has produced a
as identification.
Print Name of Notary Public
iia °�' •. MARIOA. GOMEZ
MY COMMISSION # GG 153722
,eat° EXPIRES: November4, 2021
'•.�OF F�¢.•` Bonded Thru Notary Public Undermtiters
STAMP
Revised 11/16/2016