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,KNOWL.EDGMENT
ary 0 e ublld or other officer-completingthis:
cat6verifies only the idehtitv:of:the- individual
signedthe d6cu . m, . ent ., t . o . _which this dertifidate is
ie I and not the-truthful.h.e0s..,. accuracy, or
State of,California
County of: RIVERSIDE'
'On 11.5.2020 -before me S. LUCAS NOTARY, PUBLIC
(insert name -and title of the officer)
personally emonally, appeared NICHOLAS 'ANTONY FLORIO'
who proved tome on'the satisfactory he� basis of satisfactoevidence to be the pers6n(s.) whose'naeh6(s) is/are
subscribed . to within instrument: ' I . inst' - t, and acknowledged to. e 1, th6fhelshei/they, executed th6same- in.
.p_
his/her/their authorized, capacity(ies), and- that by his/her/theira
'si n-tUres)on,the instrument he
person(s),or the entity. upon behalf of which the, person(s) acted,. executed the instrument.
I certify under PENALTY OF .PERJURY under the laws of the State of California: that the foregoing
paragraph is true and .,correct.
S. LUCA
Rotary PUbtiC L
WITNESS my hand and official seal.
Riversi8e counti
(Seal).
M, 07MI
Hlv,�?M-Ijt-, 10-iMKO!
R 'N'RT', P.',, 1"'V Vlq
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L i"Ma
1 3.IGNERANGINEER6.
C'O M F �A A MOOTGAGE' Ndt ppritabi
Name:
Name-.-
AcIldres
=Address-
(:Ity
Siate-
City:
zip. Phone
Phpne,
#Eg. glrokt T M. H0kJj5R:___x_-
Not A�pftcabl-
80104DINCS comPANY.- -L'__Npt.Applkab1.e
Na
Addre
--�'Address-
MP: . phbiaw
Zip:
OWNER/ CONTRACTOR-AFFIDVIT-1 Application is obtain -al Ic permt# to do the work and Insfallation.a's.-Indicated,
I certtfy.,that-nawarkor-installation has.ccmme6jc40.pr.icrt6t# eJ itsuance of a.p.eftit
St 14 Pj:ojntymak�soorept"inUtiont1igrantin , rm [twillauthorim the permit holder tobuild*thetobiect-ktrurturp.
Inconsideration of the granting ',,Qf. this ,rq uestea-liermtt, I`do :.heitbyagreethat )-'Will, In all respects, perfban-the work
-
ln'ac66r&ncewith 'the ,approved .plops, the Fl&jd9,B6iIdjhg..Cpdes kid StUrle-Couqt.y.Amendmenis.
peftItapplicatibM:are exempt from..uiidorgoing a full cohcu'F'ren0.rewew-.roorn addWoM,,
accessory structures, *mMing pools; f-eincest Walts;slgn; kreen'robmi§ and accessory uses to another non-residential use
WARNINO.'T10 QW111Ek: Your fa! Wreto 1144drd.ai'Notice of taftnenceivient.miV resu . tin-oa*gUice f6i
impr overnentit,6-yo_U"r PYOO-eitj� A Nofidi of Carriffien'cerrient must,be rec&46cl In1he public-recor& of St.
Luche -Cou* -iiid poited. oti the jbbsjti !��. e flr. 0 . ed.. I If 'd t' dbt�kflhancing, consult;
s Inspion. y'rju intent! 0 n
wfthAender'.6-r-g-n ktfwnevbefbrnc!nL7w'nrk.nr rpc_nrdincrvniir Nnflva of erimmianrammnt.
6 zltum oown2ssWCbntract6rasAgeiitfor'owner
SignatLiee�.cf-Cop'r tdrjl#eosi HPIdqr
'STATE OFFLORIDA
STATE 6FAMDA
-COUNTY Of
COUNTY OF-
-Sw(drn to:(or ieirmed). and subsoibed .'before -melof
S.wdrn to -Or affirmed) and subscribed. I before me -of
Phyejcafftes6xi�e or dniiii'ehotaiti4ion
Physical'Pres'erice orOnlineNotarizatLan
this -day of - -.2020. by
this dayof :202o'by.
Name of peivon irtakinestatprpent
Name -of person.mAkths-statement.
.06rsonalli'Known OR' Produced Ident* tiol
personally'Known OR Produced IdentificationType
of"Idiritification
Type-cfldentlfhsitiqn
Produced
-Producid'
(4ig6pture-dfNbtary, ' public State.of Florida).
(S!gniturL--of!NdfaryPublic-;Statp,:of'F.faiida:
:COMMISSIbli-No. (Seat.):
Comr.nUsibn_Nio. (Seal)
:REViEWS,
PR.NT
ZONING
SUPERVISOR
LANs
PLANS
VEGETATION
SEATURTLE
MANGROVE.
COLINTER
REVIEW
IREMEWRE
R
VIEW
REVIEW
DATE'.:.,
RECEIVED
'DATE'
COMPLUED,
I
Kow:57672D
public or
Who: signed `the docu.n e
is attached,_and,,not.the
fcer completing, this
identify of. the individual
to, which this. certificate'
athfulness, accuracy, or
State of California
County of
Subscribed and sworn: to (or affirmed) before: me: on this 5TH
day-ofNOVEMBER. , :20.20 , by
proved to me on the: basis,' ofsatisfactory: evidence: to be the
person(s) who: appeared before me