HomeMy WebLinkAboutOwner Authorization OFFICE USE ONLY: DATE FILED: PERMIT#« Yn �q_j�,5
Cast: $55.00
� IIIIIIIIIII I� PLANNING&DEVELOPMENT SERVICES
BUILDING&CODE REGULATIONS DIVISION
s 2300 Virginia Avenue
Ft.Pierce,FL 34982-5652
772-462-1553 fax 772-462-1578
APPLICATION FOR TEMPORARY USE PERMIT
BUSINESS NAME: CX
NAME OF EVENT: 1� 1°� /Fow
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LOCATION AND ADDRESS OF TEMPORY USEV T:
PROPERTY TAX IDENTIFICATION#:
DESCRIPTION OF TEMPORARY USE: P Vol
DATES OF THE EVENT: a-4, 4! q yn• "f D }✓h
APPLICANT'S NAME: Qri nG+ A2U— I f 2'
APPLICANT'S STREET ADDRESS: eio �c
CITY: pg. A e nt e STATE: ( ZIP CODE:dllirz
WILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES NO
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WILL THE EVENT HAVE A TENT(s):YES CA NO_(up to 900 square feet exempt from fire permit)
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WILL THE HAVE BANNERS/PENNANTS/FLAGS?YES /NO (Only 1 per 300 linear feet;32 sq ft max size)
I HEREBY ACKNOWLEDGE THAT THE ABOVE INFORMATION IS CORRECT AND AGRE TO CONFORM TO
ST.LUCIE COUNTY LAND DEVELOPMENT CODE,SECTION 8.02.02J.
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PRINT APPLICANT'S NAME SIGNATURE OFA ANT
STATE OF FLORIDA,COUNTY OFL Luce
ACKNOWLEDGED BEFORE ME THIS DAY OF (►� ,20 ,
BY ^uC� iC'.1 k Ila e-Z WHO IS PERSONALLY KNOWN TO ME At:f-,—
OR WHO HAS PRODUCED Ill L A AS IDENTIFICATION.
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SIGNAtftf OF NOTARY TYPE OR PRINT NAME OF NOTARY
TITLE: NOTARY PUBLIC COMMISSION NUMBER:G-6--j- -.� 31
SLCPDS 10/19/2015
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