HomeMy WebLinkAboutnew Subcontractor PERMIT# ISSUE DATE
F�T LOCH PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
COUNTY
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
S �, —�R- have agreed to be
(Company Name.dividual Name)
the ` —�TQ- Sub-contractorfor?tk LAC-
(Type of Trade) (Primary Contractor)
For the project located at (4-"C)'6C
(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) SUB-CONTRACTOR SIGNATURE(Qualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of --} (�VLc✓� State of Florida,County of
The foreeggo_in`g instrument was signed before me this day of The foregoing instrument wassigned before me this-&day of
T� 20 4y 20bp
who is personally known_or has produced a L who is personally known_or has produced a f/
as identification. Q� as identification.
�f STAMP STAMP
Siinatlire of Notary Public Signature Notary Public
140
Print Name of Notary Public Print Name of Notary Public
" HEATHER BURFORD
`2p4PpY�'`BState of Florida-Nota18 Public
32t7
♦- CommisslOn # GG `�20�Pp�'P�e�� H
Commission Expires State B
` February tate of Florida-NoRFORD
Revised 11/16/2016 unn`` =; o°c Commission # 3217 tary Public
Y Comm ssio�G
FebruaryExpires
Og 2022
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