HomeMy WebLinkAboutSub-Contractor AgreementPERMIT# I I �3 �Q—I�� ISSUE DATE
_ PLANNING & DEVELOPMENT SERVICES - E C l_: 4 , :.
P UPTIJ YE It Building & Code Compliance Division
• APR 13 2017
BUILDING PERMIT PERt'JIITTI VG
SUB -CONTRACTOR AGREEMENT St. Lucie County, FL
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if appiicabie): EC0001643
Centerline Solutions / Todd Schlemmer have agreed to be the
(Company Name/Individual Name)
ELECTRICAL Sub -contractor for Anthony Ankersmit / UCI Construction Services, LLC
(Type of Trade) (Primary Contractor)
For the project located at 9901 Range Line Road, Port St. Lucie 34987 VZW 68828
(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
Address: 7103 East 6th Avenue
City/State/Zip: Tampa, FL 33619
Phone: 813-386-6202 email: ddrury@ucics.net
Anthony Ankersmit 4/7/17
SIGNATURE
STATE OF FLORIDA, COUNTY OF
PRINT NAME
Hillsborough
DATE
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS 7th DAY OF April 20 17
BY Anthony Ankersmit WHO IS PERSONALLY KNOWN X OR HAS
PRODUCED AS IDENTIFICATION.
be)bro,irk- Debra M. Drury (STAMP)
SIGNATURE OF NOTARY PUBGC PRINT NAME OF NOTARY PUBLIC
SLCPDS: 08/06/2014
DEBRA M. DRURY
e , . Notary Public - State of Ftorida
Comolission #.EF 973213
My Comm. -Expires May 2B„3020