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Building& Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-1553 Fax 772-462-1578
ASBESTOS NOTICE TO CONTRACTOR
Date;
Contractor Name:
BusinessName: M O E, 1
Addnims: 3 '' AJ USb"
City: u>Ya State:
Zip r.0de: 2-q Z� _
Re: Job Address: 401 A) 0,94, lo+
It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes
and tcl notify the Department,of Environmental Protection of any intentions to remove
asbest-. when applicable in atxordance with state and federal law.
Si nature & Date
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