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PEA �PTITVRINQG -At D E
R -VE JL G PA, 11-E NTT RV IC E s)
BufldhLn CDr.qn,�- A1� ' 1
014I
ny Name,
—Sub-cwnt'-ractor for
iff-ype of -Frade)
For the im-oJect located at F
V, bV %I
.,Project Street AdidregS or Property Tax TD
ha-ve agre-d u,
-S understood fnaL. ?fthere- ig an -V c�Iarl.qe Of Stutus rc�a-L-,?''rLL9 01 'r P, Qipa with the abov4,- -TrenT icm--d
, az-
y and Code Regulation Division of St. Luicir� County wil i be advised -Durguairt to the
11-1 -
I - Sub
%1 12i ofa C-nan
ge'o �-contractor
C T TR"
e
RRINT NAMR
U 'I
'cv�olb I
stite r"; Flori&' cammw yt-
'!'Ile fOre nssa in-sh-u-MA Was Signed before me this day' cf
by
ivh;);s persi)na-ily knuivn —0k, has producell a
IF N'VlmeY Public
tlri- LI -U,44 -t) -
Prins Name of Now-; Public FwNe",—o4 v -
PUN, Commission# GG
Ii I
1�v'-"Sed 1 i � � 6-'2016
SUB -C-0; 'It SIGNATURE (Q4mH'!e'-)
DZNU� Rust r
I
PRINT NAME.
C.Fc
COUNTY CERT1911CATfON' NUMBER
_Y' PtU-,jdYa. of
Tile krrephl-'mstynmen' , wns sigued iefore rne th-'-s zP).1; of
Who is rkersamilly "'no", 7, —or 1121S prftduced a
;t itertiiiruiion.
6-45 —f
skpla tu re Qf Natar y P11 bhe
�p�pgy qhs A. Doreen Langford
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5 --int -h=a z _STATE
AT
STE OF FLORIDA
Comm# GG043591
Expires 1218/2020