HomeMy WebLinkAboutSUBMITTED PAPPERST. LUCIE COUNTY PERMIT APPLICATION
PERMIT NO. %�5 750 & SEWAGE PERMIT NO. //66 0
APPLICATION FOR PERMIT TO CONSTRUCT
JOB LOCATION/ADDRESS:
LEGAL
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ARCHITECT: • NAME
ADDRESS
PHONE
CONTRACTOR: Ok NAME -/� �� State Cert./Reg.
ADDRESS PHONE
`OWNER: "'AME jt (if Corporation, List ADDRESS 126 / -� PHONE 8 -�O ` G
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�\ Nhme of President)
` PRESIDENT ' PHONE -- --
"STATE OF-FLORIDA, COUNTY OF ST. LUCIE
Before me, the undersigned authority, personally appeared who upon
being duly sworn, deposes and says that the information cotaineddinin the foregoing application is true and correct.
t �
\ Applicant /J'U
\%
Sworn to and subscribed before me this � r` \ day of
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0/ j�S S, My Commission expires: BONDED THROUGH MUROSKI-ASHTON. ING