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HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENTll G J� lee er-► c- PERMIT# ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division RECE11TO SEP 04Zan BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: JQ 1 i `7 1 State of Florida Certification Number (If applicable): G ` I -g©058,5 g Name/Individual Name) (Type of Trade) For the project located at Sub -contractor for 01VyUA_ (Primary Contractor) (Project Street Address or Prop6rly Tax ID #) have agreed to be the It is understood that, if there is any change of status regarding our'participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNA Business Name: Address: City/State/Zip: ARE REQUIRED zic, jPhone: ' email: i �� e _ LAG ! C?c,.L .0-on, Pr il 9103L W URE CV PRINT NAME DATE STATE OF FLORIDA, COUNTY OF --f>T— Lu �(j z THE FO�REGOf-ING INSTRUMENTWASSIGNED BEFORE ME—THIS-0 DAY O��YJ'L� , 20� BY _ U _([ ��V�?_ �` I�'� [ CL�- WHO IS PERSONALLY KNOWN><- OR HAS PRODUCED AS IDENTIFICATION. roe FAYEEITLFATRICK o•" ... `"� My COMMISSION # EE ti2165 * :August ary'Servl (STAMP) es SIGNAT RE OF NO ARY PUBLIC PRINT NAME OF QP I�i�Bpd� rgTf OF F��P SLCPDS: 12/16/2013