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1YPERMIT NO.
APPLICATION FOR PERMIT TO CONSTRUCT
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LEGAL DESCRIPTION -__''�*��
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(CODE ) SEWAGE PERMIT NO.
ROAD IMPACT: DISTRICT ZONE___-___--_
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10
LOT BLOCK ______ 'UNIT __SE[
PR[)PERTY TAX |D 3 .2 1
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FEE
Date i—onOU Ind. Of
FLOOD ZONE _______ELEV_______
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RGE
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EST COST
SET BACKS: 8A[K3. FRONT REAR ��
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LIVING AREA
ACCESSORY
ARCHITECT:
NAME ____
PHONE
ADDRESS _-__ CITY _-_
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CONTRACTOR:
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STATE
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OWNER Up NAME
PROPER|y: �
ADDRESS
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CITYSTATE ZIP _j_qYfjv
STATE OF FLORIDA, COUNTY OFST. 0[IE
Before me' the undersigned authority, personally40
being duly sworn, deposes and says that the information appearedion is trUe and correct.
Sw `,n to and subscribed before me this
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Notir �Publ�icSt;�aV�eo
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SCHOOL IMPACT FEES
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Date Pd
Posted_____
1,55.22
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