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PERMIT NUMBER• ! 33 i
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ST. LUCIE COUNTY
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DEPARTMENT OF COMMUNITY DEVELOPMENT
2100 VnWiNM AVMM, ROOK 201
n Y PORT PIERCE, FL 36982-5652
607-662-2553
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APPLICATION FOR
TEMPORARY SPECIAL, EVENT PROMOTIONAL FLAGS, BANNERS, &
PENNANTS
DATE:
LOCATION/SITE ADDRESS:
PARCEL ID NUMBER:
SECT
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iREPORT CODE:
0907!
NUMBER OF TEMPORARY'SIGNS/BANNERS:;
DISPLAY PERIOD START,DATE:
DISPLAY PERIOD ENDING .DATE: Z
TOTAL NUMBER OF DAYS: b
4.
Name:
Address:
City:
Phone:
OWNERS INFORMATION p 5. APPLICANTS INFOR TION
Name:
Address: 5 �� \
CRY: ��� p 1 St:
.Z) �k� Zip: 3�C` S� Phone: ��c\ - 3�� "���o� Zip:
FEES DUE: Q 1 0y
RECEIPT: 0 1 l 3 36.5_q
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in compliance
with all applicable laws regul g construction and zoning.
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF
THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS DAY OF , 19_,
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY (seal)
NOTARY PUBLIC TITLE COMMISSION NUMBER
NOTE: ACCORDING TO SECTION 9.01.02 (C), ST. LUCIE COUNTY LAND DEVELOPMENT CODE, NO MORE THAN (4) PERMITS PER YEAR SHALL
BE ISSUED TO ANY ONE PARCEL OR COMMON DEVELOPMENT SITE FOR NO MORE THAN A TOTAL OF SD(TY (60) CALENDAR DAYS PER YEAR.
SLCCDV FORM NO: 019.01