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HomeMy WebLinkAboutSUB-CONTRACTOR AGREEMENT4 PERMIT# ISSUE DATE PLANNING & DEVELOPMENT SERVICES COUNTYBuilding & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT SUgr4, SCANNED By St. Luca County (Co pany Name/Individual Name) the Sub -contractor for (Type of Trad RECEIVE® DEC 0 9 2016 i uRMITTING St. Lucie County, FL have agreed to be 1. MA' e- C "Do (Primary Contractor) For the project located at R 0 3 A ",,, (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. — ps" 4 W_0�__k CONT OR SIGNATURE Qualifier)to-A,t e. ler PRINT NAME COUNTY CERTIFICATION NUMBER State of Florida, County of ST Luc, e— The foregoing instrument was signed before me this day of 2ok by who -is personally known _or has produced a as Print Name of Notary SUB -CONTRACTOR SI NATURE (Qualifier) `ZnJe.1_l2 t W,4/ kr PRINT NAME Uj(' R�1-1 1�'© R COUNTY CERTIFICATION NUMBER State of Florida, County of -tb c- f Q_ The foregoing instrument was signed before me this -; — day of 20A, by who is personally known elor has produced a. as identification. STAMP KA R E N S. N I E L S E N 01guururo of nuiar r uuuc Commission # FF 115637 . ,..'P'°�B'- KAREN S. NIELSEN My Commission Expires ;';�"�= Commission # FF 115637 June 2, 2018 Print Name ofN +F My Commission Expires n „nn1noF0 ` June 12, 2018 Revised 11/16/2016 PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT / St. Lucie County Contractor Certification Number: `� / r s— State of Florida Certification Number (If applicable): 93C -Z� J )2s have agreed to be the (Company Nathe/Individual Name) V 1l3 Sub -contractor for S 0 r (' S4- C- C �0 (Type of Trad (Primary Contractor) For the project located at 2- 96-3 4%tiD�-rsah (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, 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 SIGNATURES ARE REQUIRED 1 Business Nam �'�� `� /� G I-r C- Address:� 2 G �,,d�n+ I',, I, % Cvi. -L, C itv/Ctat�/`r7 S� email: 5 "04 C al'a. PRINT NAME DATE TE OF FLORIDA, COUNTY OF f—. lcc_ e_._e ;HEFOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS '4 DAY OF ,� � �� r , 203_), By_ " 'ej__ a r c7C s WHO IS PERSONALLY KNOWN OR HAS PRODUCED 1-J-0L AS IDENTIFICATION. - u� (STAMP) _ Z�C.- S GNTURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC Si — DS: 08/06/2014 ,, JUANITA GELTER Notary Public, State of Florida 1%] Commission# FF 153639 My comm: expires Sept: 912018 5��