Laserfiche WebLink
AFFMAVIT OF EXET�Y- TION EFFILICATION FORM (A <br />PROJECT NAME (PRINT): Three Southern Oaks <br />NO Pre --"P Three Southern Oaks <br />Pre -application co erence project name � number: <br />Computer assigned project #: 2015100082 -- -7S--l-71 Plan #: AOIr Irl -05- 6 3 <br />OWNER: (PLEASE PRINT) <br />Three Southern Oaks, LLC <br />NAME <br />105 40th Court <br />ADDRESS <br />Vero Beach, FL 32968 <br />CITY, STATE, ZIP <br />772-770-2670 <br />PHONE NUMBER <br />phg19@aol.com <br />EMAIL ADDRESS <br />George Williams <br />AGENT (PLEASE PRI ND <br />NAME <br />ADDRESS <br />CITY, STATE, ZIP <br />PHONE NUMBER <br />EMAIL ADDRESS <br />CONTACT PERSON CONTACT PERSON <br />-- <br />SIGNATURE OF OWNER OR AGENT <br />PROJECT ENGINEER: (PLEASE FI IINT) <br />Carter Associates, Inc. <br />NAME - - <br />1708 21 st Street <br />ADDRESS <br />Vero Beach, FL 32960 <br />CITY, STATE, ZIP <br />772-562-4191 <br />PHONE NUMBER <br />johnb@carterassoc.com <br />EMAIL ADDRESS <br />John H. Blum, P.E. <br />CONTACT PERSON <br />PROJECT SURVEYOR: (PLEASE PRINT) <br />Carter Associates, Inc. <br />NAME <br />170821 st Street <br />ADDRESS <br />Vero Beach, FL 32960 <br />CITY, STATE, ZIP <br />772-562-4191 <br />PHONE NUMBER <br />davidl@carterassoc.com <br />EMAIL ADDRESS <br />David E. Luethje, PSM <br />CONTACT PERSON <br />180127" Street, Vero Beach FL 32960 <br />F:1Community Development\APPLICATIONSIC urDev applicaiionslAffidavit of Exemption App.rtf Rerind Apn120I6 Page f 2f 2 <br />