HomeMy WebLinkAboutProperty Owner InformationSPECIAL NOTICE
(PLEASE READ BEFORE SIGNING ACKNOWLEDGMENTS BELOW)
Submission of this application does not constitute the granting of approval. All appropriate requirements must
be met prior to this project being presented for approval to the appropriate authority. St. Lucie County reserves
the right to request additional information to ensure a complete review of this project.
ACKNOWLEDGMENTS
A licant Information (Property Developer): Agent Information:
Business Name: IAdhael 5CA4 COA!�" Business Name:
Name:'IPyIM_�F�lf - Name:
Address: _-�;�g1 G 1 di u��y Address:
(Please use an address that can accept overnight (Please use an address that can accept overnight
packages) packages)
Phone: 5 te9- 155 3 Phone:
Fax: Fax:
Email: '} V'; er-V eb ,P r-al. C-0 9a Email:
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Please note: both applicant and agent will receive all official correspondence on this project.
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Property Owner Information
This application and any application supplement will not be considered complete without the notarized
signature of all Property owners of record, which shall serve as an acknowledgment of the submittal of this
application for approval. The property owner's signature below shall also serve as authorization for the above
" applicant or agent to act on behalf of said property owner.
ZZZ,
Property Owner Signature o
Mailing Address: `624'1
Vex
Ch -�Jl'•-cr4.a
STATE OF RA a, , COUNTY OF ]�:ndi G^
Property Owner Name (Printed)
Phone: 7qa . 5[d7-J5rj•3
If more than one owner, please submit additional
pages '
The foregoing instrument was acknowledged before me this day of , 20z
by g>1a— who is personally known to me or who has produced
as identification.
Signature of tary Type or Print Name of Notary
Commission Number (Seal)
Page 5 of 6 9ND
RIPPRevised March 15, 2016043223r 8, 2024480,�7019