HomeMy WebLinkAboutChickee Location Permit Permit Number `� -^✓ c7�� `-1
j
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
CF • Building and Code Regulations Division
• 2300 Virginia Ave RE�EIVEp
Fort Pierce,FL 34982 tOCT
(772)462-1553 X 1019
Per►nitting Depart
St. Lucie county
APPLICATION FOR CHICKEE LOCATION PERMIT
SITE ADDRESS:
PROPERTY TAX IDENTIFICATION#: � �
APPLICANT'S NAME: wub hcl
i
APPLICANT'S ADDRESS if different from above:
CITY STATE: ZIP CODE:
A.
SEMINOLE R MICCOSUKEE(circle one)TRIBE ENROLLMENT NO�V coca CONTRACTOR LIC NO.: e a
CHICKEE HUT DESCRIPTION OF MATERIALS TO BE USED AND SIZE: CC C65cf 3a I(�
1�, X An �\r`C+C U \2r)OC �t1\C� �-11�\ �nU t;�b�d 4- QG�`nn 'rS CO YAS
I HEREBY ACKNOWLEDGE THAT THE ABOVE INFORMATION IS CORRECT AND ACKNOWLEDGE THAT THE CHICKEE HUT TO BE
CONSTRUCTED WILL NOT INCORPORATE ANY ELECTRICAL,PLUMBING OR OTHER NONWOOD FEATURES.
" '� ELLEN VAUGHN
SIGNATURE OF CONTRACTOR OR �4o,nr PUp//
Ai° 4o'-_State of Florida-Notary Public
OWNER/BUILDER Commission.#GG 270079
°.' My Commission Expires
October 22 20.22
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE MME THIS _ DAY OF -Ur C 20
BY ac c " N,�_ eJL- WHO IS PERSONALLY KNOWN TO ME(_),
OR WHO HAS PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY ``__
For office use only �� ��}� V V,
Zoning District: Setbacks: front: back: side: rear: C��`vc,�C-L a
Setback verified on plot plan: Yes/No
i
o ! ! JA !
v
JEL Vol
Ao
� �+ �= -� A4Ci�IRSEDBBtMjCABOYEPRQ�t•R7YttNESItYAl101YSj
mi
fiewwA m SB9°28`26 92.5
&WaI � YAGIMItAMD � S
NOlJBS7RUCllOMS
R�
ai�ttr
MIN.SETBACK REQ.
FRONT
SIDES
CNR SI
REAR
ZNG.
TE
BOUNDARYand TOPOGRA
PHIC SUR VE)
i GRAPHIC SCALE
w o zo w 00
IN
i
{ IN FEET
1 inoh = 40 ft.