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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance.]Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
St.Lucie County.Contractor Certification Number:S— 1
State of Florida Certification Number(If applicable); 00 5 1
v" I'���I � ��l C_ have agreed to be the
(Company Name/Individual Name)
e\f_,' i C rx Sub-contractor for (}' -on n e l— f� L i_Cr
(Type of Trade) (Primary Contractor).
i
For the project located at 1.52-q No. llf myi(b sh C�r, kin') dy
(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
Business Name: N) rper'lj_�_
Address: Foo
City/State/Zip: 1,�e� 3 c9 4-
Phone: (, " O W email: W 4'CeK kL 1 � `k-v �<
SIGNATURE PRINT NAME DAT
STATE OF FLORIDA,.COUNTY OF a,Luc I.&
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS J_DAY OF A.A, Q 4 ,2r~15
BY i5r( C„ Lf+n tkf mez)y.., WHO ISPERSONALLY KNOWN OR HAS
P UCED AS:IDENTIFICATION.
a��_
�G ( C211 1) tVllrl�l\� (STAMP)
IGNATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS:08/06/2014
M(407) !
HEL C ODONNELLCOMMISSION#FF100209IRES March 10,2018FloridallotaryService.com