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ST. LUCIE COUNTY PERMIT APPLICATION
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PERMIT NO. _ 7 rg
(CODE # ) SEWAGE PERMIT NO
APPLICATION FOR PERMIT TO CONSTRUCT — 21,Y C-'f U`G2.f �y
JOB LOCATION/ADDRESS: �! Ue✓---�//e ,S/C
LEGAL DESCRIPT ON anS C ea fl� 1 r C �p �(}� -Q_
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ROAD IMPACT: DISTRICT _ ZONE FEE
S/D MAP # FLOOD ZONE ELEV '
LOT BLOCK / UNIT SEC TWP RGE
PROPERTY TAX ID # / 30 �� j Q Z1� e?�2J �J
ZONE — GMPP n '�
LOT SIZE/DIMENSIONS X ST COST
SET BACKS: FRONT 3QjREAR SIDE SIDE a�
SQ FT BUILDING: LIVING AREA / /� _ ACCESSORY
ARCHITECT: NAME PHONE —
ADDRESS — CITY ST ZIP
CONTRACTOR STATE REG/CERT # _ COUNTY CERT #
NAME6;�4p 0 r' er ADDRESS (� 6 Q CajQ1 UQA^v I Q-f (qC Q—
CITY Qg -r- - STATE' ZIP _ 7 �" PHONE �Jr 75l a
OWNER OF
PROPERTY:
NAMES-c'
ADDRESS{ C2 11Q rc� �t s a,, PHONE _
CITY `� T - �� C STATE r
ZIP
STATE OF FLORIDA, COUNTY OF ST. LUCIE
Before me, the undersigned authority, personally appeared who upon
being duly sworn, deposes and says that the information contained in the foregoing application is true and correct.
Applicant 7 Sworn to —id subscribed before me this
day of 19ri0'� ,ir.
S7 1 ,,TiC C ,"'' '! PROPOSED P E'71 AD-,ITI���LS 1J rT.
SCHOOL IMPACT FEES At�D70R > XCI
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Required ❑ Ye's
Notary Public, State of Florida at Large Amt. Pd
My Commission expires:
Date Pd Posted
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