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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF5r LO e, t COUNTY OF.i Cued
The foing instrument was acknowledged before me The forgoing instrument was acknowledged before me
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this day of z%jovem6ejL , 20 11 by this day of No VCM 6 -e , 20 by
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
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(Signature of Notary Public- Stat T 10 (Signature of Notary Public- Stat )NOTARY (C
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Commission No. Commission No. ,�
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Expires 20 ExPlifes 20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Date: 10/20/19
Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349R2
Phone: (772) 462-1553 Fax: (772) 462-1573 C®i'11YY1CrCIBI �Sideiltia0 >�
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REPLACE 8 IMPACT GLASS WINDOWS SIZE FOR SIZE
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Additional work to be performed under this permit —check all that apply:
_(Mechanical
_Electric
Gas Tank
_Plumbing
Total Sq. Ft of Construction: 2528
Cost of Construction: $ 7968
Name DARRELL MARTIN
Address: 4903 SUNSET BLVD
City: FORT PIERCE
Zip Code: 34982
Phone No.772-462-1673
E-Mail:
Fax:
_ Gas Piping
_Sprinklers
_Shutters
_Generator
Sq. Ft. of First Floor: 1486
Lot No. 19
Block No. 46
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Roof
Utilities: _Sewer _Septic Building Height:
Name: ROBERTO SANCHEZ
Company:
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State: I Address: 6500 NW 12TH AVE #110
City: FT LAUDERDALE
Zip Code: 33309
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Pitch
12'
State: FL
Fax: 407-3748-6681
E-Mail richie.roberts@expeditepermit.com
State or County License CGC1522717
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