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PERMIT # ISSUE DATE
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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -'CONTRACTOR AGREEMENT
z
dLl 'P�L ./ - , have agreed to be
(C m ny Name/Individual Name)
the /1'�9 '8 I.AJ�ij Sub -contractor for Z Q Un'lt_x"?
(Type of Trade) (Primary Contractor)
For the project located at 27D.3 16W R AJ'# D"e
(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.
ONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
L'U C/ /
COUNTY CERTIFICATION NUMBER
State of Florida, County of \ P
The foregoing instrument was signed before me this -/— day
of
who is personally known Lor has produced a
en ca pn.
/) ST
a u e o No r. ublic
Print Name of Notary Public
9111�-CONTRACTOR SIGNATURE (Qualifier)
9`� 6 � <
PRINT NAME
SU
COUNTY CERTIFICATION NUMBER
State of Florida, County of /
The foregoing instrument was signe before me this ,L day of
Zt by
vho is personally known has produced a
Print Name of Notary Public
S;1ERtti F&;L Pw)
MY COMMISSION I FF 100370 .'' . `•� 1%R; i (-c„L ipA?1
EXPIRES: March 14, 2018� .�, * MY COM"„ISSICN # FF 1003; 0
Revised I I/16/2016 s� , aP Kv_ ,
ATFOFF"��\ Be00edThru C3udaetNotarySeNicee sjga4 0 E,SPIRES: March 14, 2018
�OFFV BordedThruBuegetNotaryServicoF
ST i LUCIE 'cow
�V ; I
J��TIg.DIIVti,, EMT '
8v13-CO Q.p AgRtEEw
St Lucie County Cohtractor Certification: NUmber.
State of f=loridd Certificatloii Number (It ipplicable): e l ! Cep z 7
„.
P1
ha's-:agreed to%be
(compdnylipdivklUel barn®)
.,• ,,.
the sub-cgntracto:
(type'or oonsWquon tried-) ' "• t
:•(name of Ih®:pdmd•eontrador)
for'the project located at -L2�_3��" •�/ :. It is understood that, r
;��.
(street addres9• or properly tax io'd)
i
if there is any change of status regarding our participation.'With the above mentioned
project, I Will immediately advise, the Comm 'I :Devi opment Department (Growth t
Mat agement: bivision)::of St. Lucia; Coun b ' iy y Yp rso all `filing .a Change bf Contractor
Form (SLCCDV FORM N:o: 004-00).
• ir,S.o i,eat i. at
BUSI� qUA (orlgInatsI96dtured tequlred):
signatu :. ' ' print 6 ' Z�
p,. t nom� I date
business no e: •: ; . I 1` G, �`� ,
address:
clty,state,zip: t .,t" ; ;i ' '
phone:
f ! I sLccDV poRM NO.: 002-00
' PERMrr # ISSUE DATE