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ST. LUCIE COUNTY PERMIT APPLICATION
PERMIT NO. .— `�—. ( CODE # ) SEWAGE PERMIT NO. �—
APPLICATION FOR PERMIT TO CONSTRUCT RA4_A� l
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DESCRIPTIONLEGAL !Q a
ROAD IMPACT: DISTRICT ___ _ ZONE — FEE — _
S/D r Chit _ MAP #— FLOOD ZONE ELEV --
LOT BLOCK — UNIT SEC Y_V__�Ca_ TWP s1� — RGE QFZ
TAX ID #__,Q 3 — O O —n C3p�_ -- — —
GMPP
LOT SIZE/DIMENSIONS Q0Qr v EST COST�102•Qe
SET BACKS: FRONT O/ REAR _szQ— SIDE KQ"ai
SQ FT BUILDING: LIVING AREA — ACCESSORY 40
ARCHL CT: NAME PHONE —
ADDRESS
ZONE
CITY
ST ZIP
CONTRACTOR: STATE REG/CERT # �_ �C 0' 0 _ COUNTY CERT #
Y\�P 11 uu t'
NAME S) n
tii (I ADDRESS _1 _L
CITY �' C�C=� STATE ZIP PHONE,-0
OWNER OF
PROPERTY:
NAME _�"_
ADDRESS L �� Q I U 2-Z'j(Q PHONE _
CITY 1::f �A-�%5- STATE ZIP
STATE OF FLORIDA, COUNTY OF ST. LUCIE
Before me, the undersigned authority, personally appear
being duly sworn, deposes and says that the information cont
a' d rn a fore ing
Sworn to and subscribed before me this
[u% u'
Applicant
ti
_ day of _ 19
SCHOOL IMPACT FEES
Required ❑ Yes ❑ No
upon
Notary Pudic, State o lorid at arge t
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My Comm,sion expires. , I
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