HomeMy WebLinkAboutNotice Of Vegetation Removal Application 3 (1)UKASE UAVE THECKNO �4'LE NOTARIZED:
1 RTtFY THAT: (CITE K DINE)
A. I AM THE OWNER OF RECORD OF THE ARG E DESCRIBED
PROPERTY AND WILL BE CONDUCTTNCr THE WOIRX A5 OWNEWBUILI)ER.
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f�. I AM NOT THE OWNER OF RWOkD OF THE AaMED
DESCRMED PROPERTY; HOWEV , I HAVE AUTHORITY TO ACT AS AGENT FOR TI1E OWNED O
RBMKD. (R. Lucie C'oumy Code and Compiled Laws "wires that this a of work be done kv a kerued
consraerar, PLEASE. PROVIDE DOCUMENTATION).
I CERTIFY THAT ALL INFORMATION SU3MMED WITH THIS APPLICATION IS TRUE AND COMPLETE TO
THH BEST OF MY KNOWLEDGE,
4OWNEI&VAGdENNT �SMNATURE
STATE OF FLORIDA,
COUNTY O'
The foreping Instrument was acknowledged
before c this day of M � 1 20 P
by M uwho is
personally 1 now to me or has producod
1 as idcntification,
Signature of Notary
6�lqk
Type or Print Name -of Notary
Notuy Public Title
— G.6 v.3 9 4 2 Commission Nwnbcr
(SEAL): vv PN& 6"YNN
iva d Furidl
�w� �Caom�cnMaGG�1
APPROVED
DENIED
REVIEWED/ APPROVED BY.
CONTRACTOR SIGNATURE
'SATE OF FLORIDA,
COUNTY OF S'l'_ LUC It -
The foregoing instn=cnt was acknowledged
before me this day of__ _ _ , 2 ,
by r who is
perswrally know to me haw e d
as iden ification.
Signature of o(ary
Type or Print Name of Notary
Notary Public Title
ommi ssion Number
(SEAL)-
FO R O FFI CE USE O NJ.IV
ENVIRONMENTAL RE S OUR ES DEPARTMENT DATE
4 UPnATEn I «�/2020