Owners Consent Form_ OWNER'S CONSENT FORM
V46tna uw� ozil,iwner or,l a ti owner of record of the property legally described as:
If additional space is needed for the legal description, please check hereYand attach additional pages as necessary.
Street Address: City: Boynton Beach State: FL Zip Code:
PCN: 055 ' `� J `J ` 0 ' (�(�Gf� states that he/she has thoroughly examined and is
familiar with the application submitted to the City of Boynton Beach Development Services Department — Planning and
Zoning Division, submitted by,Gs1�L ,�.>iG on behalf ofa cAe Mk,�"4Ilf
and expressly consents to the use of the subject property for the purpose described in the application.
ignature (must be original signature)
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On thi S�
s5� day of G �20��, the foregoing instrument was sworn to and subscribed before me
by If individual: 0
and individual
IN me of Perso-7 Acknowledging)
corporation:
Do Au- L J
If �-`�--- , as
(Name of Person Acknowledging) (Position, Type of Authority, O " e iu i A
Mi
Signature of Notary
ally, Known or 0 Produced Identification
Name of Notary Printed and Commission Number
Last Revised: 02.27.2023
Tpe of identification
RM
ISON L. ORRblic-State of Floridasion # HH 349285mmission Expiresuary 12, 2027
Place Notary Seal Stamp Above
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Book16327/Page1204 Page 36 of 93