HomeMy WebLinkAboutAGENT CONSENT FORMLiberty Tire Recycling, LLC
1251 Waterfront Place, Suite 400
Pittsburgh, PA 15222-4261
AGENT CONSENT FORM
SCANNED
BY
St. Lucie County
Project Name: Liberty Tire Recycling.41'r �jr,J q,7
BEFORE ME THIS DAY PERSONALLY APPEARED KL► I'1 i �1 O6rY1��
WHO BEING DULY SWORN, DEPOSES AND SAYS THE FOLLOWING:
I hereby give CONSENT to Engineering Design & Construction. Inc. to act on my behalf,
to submit or have submitted this application and all required material and documents,
and to attend and represent me at all meetings and public hearings pertaining to, Liberty
Tire Recycling., for the project indicated above. Furthermore, I hereby give consent to
the party designated above to agree to all terms and conditions which may arise as part
of the approval of this application for the proposed use
FURTHER AFFIANT SAYETH NOT. c '
The foregoing instrument was acknowledged before me this �" day of TbEY 20�5 , by
Ke,i4-ti oOrn Lv— Name of Person Acknowledging) whe-is—persenattr
kr;eavrrto—me of wh has produce FL • 4 . L . (type of identification) as
ide ication and who id did no take an oath.
(Signature of Person Taking Acknowledgement) Owner's Signature
Plq-`ri c/ A J e-S.TJ9-
(Name of Acknowiedger Typed, Printed or Stamped)
(Title or Rank)
#'Ca- /8830(,
(Serial Number, if any)
KEr � 1-1 ��,ocirs►g1Z
Owner's Name (Print)
9 b7 S 41,Jc e L t) Pa
Street Address
?V0:-S-T—b,C.4E, t---L, 3498'7
City, State, Zip Code
----
ani's__PATaICIASESTA
Liberty Tire Recycling, LLC SCANNED
_ 1251 Waterfront Place, Suite 400 BY
St
RECEj D SEP U 8 M Pittsburgh, PA 15222-4261 . Lucie COUf1tV
AGENT CONSENT FORM
Project Name: Liberty Tire Recycling. pc"r �jc,,J l,7 7 P4arnJ(-g
BEFORE ME THIS DAY PERSONALLY APPEARED I C-i 14 �j1 obmeV
WHO BEING DULY SWORN, DEPOSES AND SAYS THE FOLLOWING:
I hereby give CONSENT to Engineering Design & Construction. Inc. to act on my behalf,
to submit or have submitted this application and all required material and documents,
and to attend and represent me at all meetings and public hearings pertaining to, Liberty
Tire Recycling., for the project indicated above. Furthermore, I hereby give consent to
the party designated above to agree to all terms and conditions which may arise as part
of the approval of this application for the proposed use .
FURTHER AFFIANT SAYETH NOT.
instrument was acknowledged before me this 84`t� day of S4AWh 20L, by
oOrnr_v-Name of Person Acknowledging) he--is—perserratig
or wh has produce FL • 4 . L • (type of identification) as
ide ication and who id did no take an oath.
(Signature of Person Taking Acknowledgement)
-Prg--7� C,, A S8sTlr
(Name of Acknowledger Typed, Printed or Stamped)
(Title or Rank)
0cc /O8.3 C)
(Serial Number, if any)
Owner's Signature
Owner's Name (Print)
9675 4%,IcE
Street Address
Fop, Srbac4e, Fu 34987
City, State, Zip Code
-e p 91015 Liberty Tire Recycling, LLC SCANNED
5�
.1251 Waterfront Place, Suite 400 St. Lucie COUiItV
Pittsburgh, PA .15222-4261
AGENT CONSENT FORM
Project Name: Liberty Tire Recyclinq. t04 h01d Pe.ryvj(S
BEFORE ME THIS.DAY PERSONALLY APPEARED I C-, I-q '16, 00me1-
WHO BEING DULY SWORN, DEPOSES AND SAYS THE FOLLOWING:
I hereby give CONSENT to Engineering Design & Construction. Inc. to act on*my behalf,
to submit or have submitted this application and all required material and documents,
and to attend and represent me at all meetings and public hearings pertaining to, Liberty
Tire Recycling!, fog the project indicated above. Furthermore, I hereby give consent to
the party designated above to agree to all terms and conditions which may arise as part
of the approval of this application for the proposed use -
FURTHER AFFIANT SAYETH NOT
The foregoing, instrument vtias acknowledged before me this 84'�' day of S1pkWb! 20J5 , by
r bOrnt,f-Name of Person Acknowledging) wHe-�s-personalty
kraevarr io-me o wh has produce FL • b . L- (type of identification) as
ide ication and who did (did no take an oath.
(Signature of Person Taking Acknowledgement)
bra--7ip -C-i S ram•
(Name of Acknowledger Typed, Printed or Stamped)
(Title or Rank)
/68 3C)
(Serial Number, if any)
'��•.PEh4^ Ba Wad7Mu WwyFubBc undervrAtere
Owner's Signature
KEG ��.oaN,�i✓
Owner's Name (Print)
9(075 )?r:hJC,6 L�nIE P—c:
Street Address
City, State, Zip Code