HomeMy WebLinkAboutAGENT AUTHORIZATION FORMAGENT AUTHORIZATION FORM
APR 3 0 2018
PROPERTY LEGAL DESCRIPTION: Island Crest Condominium I ST. Lucie
LOT NO. PLAN NO. PARCEL ID: 4511-516-0000-000-5
STREET ADDRESS: 10680 South Ocean Drive, Jensen Beach, FL 34957
Please print:
Property Owner: Island Crest Condominium
Property Owner:
SCANNED
BY
St. Lucie County
The undersigned, registered property owners of the above noted property, do hereby authorize
Julie Andrews, Hiram Matos-Pacheco of Dewberry Engineers Inc.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
10680 South Ocean Drive, Jensen Beach, FL 34957
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: Date: