HomeMy WebLinkAbout2013-09-05 (P) Acknowledgments.pdfSPECIAL 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
Business Name:
Name: /��r�-� `Y /sohh f K-eenRq
Address: t0C404 PILA,r CIZ C& I rl.
!�A . elf-(g t f�L, 3tiV►S I
(Please use an address that can accept overnight
packages)
Phone: '' 7.Q - U) 3 ` i00(0 3
Fax: ---
Email
Business
Name: _
Address:
(Please use an address that can accept overnight
packages)
Phone: 777 -y68' 9386
Fax: -172, `f65 - 65VJ _
Email: //Ptra a MW-5-c_ 0. Lnm
Please note: both applicant and agent will receive all official correspondence on this
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 a1A nt to act on behalf of said property owner.
PropeM1y Vmer nature (^ roperty vnerNa nnlettl��f
Mailing Address: ZCi 6f L)r& + Phone: '7')1- U(a?-7I IC -
If more than one owner, please submit additional
?-1WM P rL pages
STATE OF COUNTY 04260yogp�'-A
The foregoing Instrument was acknowledged before me this d;M— day of »gym rt0 , 201'-
bt��� ' i %7d1tMn who Is personally known to me or who has produced
�._. as Identification.
natule ot Not&ry eor rn ameo oery
Commission Number (Seal) PATRICIA A. ROBERTSON
NOTARY PUBLIC
STATE OF FLORIDA
Comm# DD0930415
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Page 5 of 6 g t 1/6/2013
Revised May 6, 2013