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HomeMy WebLinkAboutSPECIAL PERMIT APPLICATIONJv- 4 Sir. Al"t-+*t.xtn �a A re n� a e• NJ L aX c'ti 9 9 s..E 4FI 9 ^� �'m.--------- w:y.�^-, _" L"-MIZ@. SCANNED St, LucBY io County •a.'.L`ptfgc: 2 rat lashr Lafiv'rii idirfi uuu t iyu �74s�rr?�d°_ __ A ?` ._r i �{!a ti, lY4.'t�! ! t lrIr l.�grrq�s ( P ' O o`? s-a % 45) tJ O 0 0,0 C� 45-ezr 4. Owners infora.ead m S. Contractors information b O UA49G 4A i r r m1 1 � - ro, Dan: 3 42 s V-40ne:1pa �T2�q __2© Gad � a € WNER'S AFFIDAN IT: I Certify that all of the infori-nation Corr aired in filiS appiieation is correct and that aii work will be clone in vempliance c-'-'ith alDo lamvS _ � _ iEo C;?i;S:,'tiCi::lF.3 �=ail _ti;Pi;;p. � erY► i s �,..-..4 P T Ow NFR OR CONTiRAC YOR NAME SIGNATURE OF OWNER OR CONTRACTOR ACivvOwLEDGEDBF:Ft')RF..W—TIIIS_1441 PAYC'F t0v'i/E. �n B;. V,�e_ f- We-hj'S AS t17F.NTIFICIMON' PATRICIA y'- GARYON ` e�+g. rl ,�' A �'�Ve � & + MY COMMISSION # EE 03424E off �E'�-- _- r: +T. _ - ra — �: EXPIREO�tober 13.2014 t "" - of ,•• Balded Thru Notary Public UeMermtels Lu rI•%115SIONNaLTmTi_0� 'Ve ✓ir- .TO t)W—.J R- F'Ar..iikc WA ner•nuoi a nrsimil+ ��; . ,. . L e` _ .. , _' __.___- a- zz F, Ul.3 !'S �sD f< §'A _•�^s`€_ ¢�'+([ S', a j '::: d•:: v ...:. :�:c..-... ... .....i .'Are........ T� �nm .... - - _ _..... ... ..... ... .� ..c ac..x. a•iiiruNa.sitiv ­30i G•t Wli D.d ZlDl/8G LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CON[tNENCFNm r_ s_•REMPI T. A/C -HEAT REMPI-kCEMENT F 1rM_ CONTRACT i7i.'I.'�EM S:5(l (,Hj Nevised 04/25/2010