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HomeMy WebLinkAboutFormsi !-li1;ti rs 5i.;. l-:* l- rlAl*xffis & tlHl'Ttsrxf f; T fiEff l'Ifls.s S**ldk & {:*ds {i*u*pl**m* *ixk*ira *#l{.*tx$ Pxfr&*iT *{: $d{r4 r&*f fi }ffi &f.*fi, g$E* t :".1I +,r ltl.ri{r, i -- c00 - c ili-*firlf'tl,'.d:i1i3{.liihr'r('t'r:',r:-.lrl[.].!i"&rr']ii'rrlii';e!r'ti;'il']:11qlli!1iirfi'i ! "li:ri'!i"L;t]ff'Jlli:r'-j 1"i .:.1. ht ! ;:i.:lltl; iif!'{ :rr-"J [{i'*,-]r;i; 'r: 'l' ; rl'l . - !' :-il' 1" : '}i1i i' 'l ll-t- "'i' "'iJ'r '""'r':l "' i1';' :li rril.,l { l!".jr t:c r j \rll'*-,. lli-t.'I. ' r{ L1.*L *r.aatf, l': 2t7 y3 ffiffi'{li:*rnt.i*ffi€ffi- *6rr*sts!***a *.*ilq*3. *,LilNY t/ry'ffii*rrug+"r**r4"*l&d,h-} Y*l*d!ry iFrl+rro&6 x* *d l&* sr *-{l= ** "r , .dffi.,-*' ass. E **,3$*:Lr:-'L*k:- L,'1 *Wigurn*lf,wc f"G18F6td. ..-..-..* ri:llF JESSE DOSS Commlssion # GG 263069 Expires September 27 ,2022 B0ndod Thru gud6€tll0tary Servlqse -1FnY Pre, +u grr{rr,{/o -"M,-qJ l- *u -, 1",,r' : /v1 f,",; 'b;?;b;r:;j': *t,, lr p{r!,h 4" rtu!;r{ *r**si{::i r, +, i r,)! .rfirailrr t t.it", fkr,iir- * s{?r{*l** srr!r.g *S{*fa 03.rr r* {BEila.s O{: Xffi&: f 6tr 0. ft tSSaS CoururyrroRtDA PERMIT # ISSUE DATE I'l,A N N I N( ; & I )t,lvl,l Lo l,i\l liN'l' s ti ltv I c l,lsllrriklirg & (_'orlc (-'olrr;lli:rrrcc l)ivision llt, I t,ltl ]i{;,,t,:l{i\t l.t. st I il-(.( )N't,tti\(t.t.(rll A(; lr t,:,,:i\l tiN.t. €ea .-r Irl/, tlrc {Typc I;or tlrc projcct locaterl lt ff Srtll-cotttrlclor lor - 007 have agrccd to bc Iteor ll is undcrstood th:rt, if thcrc is any clxrngc olstltus rcg:rrdirrg our pnrticipation rvitlr thc rbovc mcntioncd projcct. the Building antl Codc ltcgulation Division ol.St, I_ucic County rvill be atlvisctl pursuant ro rhc filing of a Changc oISub-corrlnrctor uoticc. .\trtr rf l.'ltrldn. (lrunt3.rl Aatu St*lr of l-kt ld{, {iurrn ,I ' T .LLI C i -L 'l hr firrgolug lrrlt u*t(tlt rr *r riEtrr,d lw{orc mc thir -J_ drr of 5r$ rrr.hrr. -.. !u e. rrr * .;.fE_U€ Xe-S_ /4 rrhr lr prrurulll Lnnur -.*ur hirr prorlurrrt, -\r_ Life.- nho h prrrortlly lrltrnr ,**rr hl.t Irnrlilrr.rt (rr nr., ,hh nI JESSE DOSS Comnrl;sion # GG 269069 Elr;,rir e5 51.r1.,,n5u r 27 . 2022 Dofld6ij tirlr EL rl(El l{0iaiy Seftlces ",i,tc s l \\lP l(r:r iscJ I l/l(''llll(, lhG'l ,ur., . tr .. g",a,it/Jr.' * ':.tuillrill]rti "-. trrd rlaar', ,-,S Scanned with CamScanner ol'Tr;rrtci *7 lnrt'/g v) j .+/) "! O{.r / (l'rinrary (:(tnl rxc l0 r ) (Projuct Srrcr;r lD /r) ?' Ltsct s t',\r I lr . - I 1,,S-** ---&:j, t -L*.,-*{.1"*. - -"--,-. --l11ut \*llrr, 0t liol{r) l.trhll. i#No[rY Publ( stlrt. ol Flo.rd'l Lua Bortulr llv Cstrmlrrrort GG 2117 35 E;$r.0!1lr20l: -'l Planning & Development Services Building & Code Regulation Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-1553 Fax772-462-1578 Date:/0-/7-2 I Contractor Name:lr) Business Name: Address: C City:Jen fert State: Pl. zip Code: 3{Z f 7 Re: Job Address /08Yt 5| 0o*, 0. #{g fer,rcrt t*r"/, FL. 3{7f7 It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes and to notiff the Department of Environmental Protection of any intentions to remove asbestos when appl in accordance with state and federal law. /0- / y-2 t4 ature & Date