HomeMy WebLinkAboutSUB CONTRACTOR AGREEMENTPERMIT# 1703-0056 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if applicable):
EC0001643
APR 13 2017
PERfgITTING
Lucie County, 11
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 1401 Swain Road, Fort Pierce 34947 (Verizon Wireless Site # 62728)
(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: SLCCDY (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
SIGNATURE PRINT NAME
STATE OF FLORIDA, COUNTY OFHillsborough
4/7/17
DATE
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS 7th DAY OF Aprl l
BY Anthony Ankersmit WHO IS PERSONALLY KNOWN X
PRODUCED
SIGNATURE OF NOTARY PUBL
SLCPDS: 08/06/2014
AS IDENTIFICATION.
Debra M. Dru
2017
OR HAS
(STAMP)
PRINT NAME OF NOTARY PUBLI
tM UB ��i
DEBRA
M. DRURY
Notary
Public - State of Florida
° -
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Commission i.FF 973213
My Comm. Expires May 28,.2020