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PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
•
' - — — BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
St.Lucie County Contractor Certification Number:
T
State of Florida Vertification Number(if applicable):
� t
have agreed to be the
any ame/Individual Name) 61 ! �
Sub-contractorfor
(Type of Trade) (Primary Contractor)
For thero'ect located at DC F�}d� fl Q. J k3' I �c
r �
(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 SIGNA iS ARE REQUIRED
Business Name:
Address:
City/State/Zip: /
Phone: 7 W,LAW email:
SI A1W PRINT NAME DATE
STATE OF FLORIDA,COUNTY OF -LL2L-
TAE FOREGOING INSTRU�ViENT WAS SIGNED BEFORE ME THIS DAY OF 1201,io
BY r I WHO IS RSONALLY KNO OR HAS
a�OCED
PRO IDENTIFICATION.
(STAMP)
I'V-101 b ,V/1
PRINT NAME NOTARY P11BLIC LIBERTY KING
SIGNATURE OF ARY P C �.
MY COMMISSION It EE 877248
SLCPDS•08/06/2 14 ` ` EXPIRES:May 4,2017
A F°� Bonded Tbru Notary Public Underwriters
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