HomeMy WebLinkAboutLey AC Change out permit app pg 2 001tea♦ --
't#
kFEE SIAME TIREHOLDER: Appli
ita-s.
Zip-- Mom-
. 7,litl 4` c.Q0 _ •E Yt - ._,4 tT. a s Y� Y Z7L. Ai# t it
•-f Y r-•Y fk-a
ermit hotderto biAd tine subje€t sbmcture
cuuenantstinat nray restrict or�arcai` ibit such
R` arEy re3tf'�tiCraS Nr�atCl's may Srrysry.
-
i ! . .T�' r , Y ... x# s=a a- #: .:f a •y .a::a a...r: - . t, 2` #
401d�e(r�/i
SWotureof0amerf ipe55e2�inntratlJ) AgentfCP tiv er
A � �N
ACOMM; 6
��
}��7gpi�lnt44STAT��Uiir��eryyOffcy�ontiactur%1.ICense
�A
FLORIDA �I
O •1
CO OF �/IV
The iorgc9ng 7resfrsnnarf was ac rrswriedged Mare me
The forgoing inshaa�rrent wras acknowledged before me
this'(iti dayrrt 20'Lr7 by
this�-It-dayofVV'U_,_,t& ,2020 by
M t fi
3—CY t3 GD!&
Name of PaIrSW/Xalting Sthelueft
Narrre a€ star t
PersonallyKnows OR Produce$ ideroftation
Personalty Knower vflR Pradrrced iderruCraatian
Type of ldenfification
Type of Identification
Produced
Produced
(Signature o€i `2� ri,�-5No +WELL
(Signatureof No `f ¢a �}State of Florida
_ #
' r •= Commiss))'¢¢n__''#� GG 017639
Gcammrscwn Na_ ``� o= Comm. PxF4Y Aug 21, 2020
a # �r`�6 Notary Public - State of Florida
fomm#ssrrur Commission #(7839
Bondedthrough NationaFNotary Assn.
•'o',? F�q? ` y Comm. Expires Aug 21. 2020
- Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPO"FIS€ R
MM
VEGETATION
SEAT!lRTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLUM
Rev- BM17