HomeMy WebLinkAboutGolden Ponds - 435557r9
ST. LUCIE COUNTY PERMIT APPLICATION
PERMIT NO.~� �. ( CODE SEWAGE PERMIT NO.
APPLICATION FOR PERMIT TO CONSTRUCT 1-, nS) P,-T % 4 i
JOB LOCATION/ADDRESS: __-3?j_
LEGAL DESCRIPTIONT1 0 p
ROAD IMPACT: DISTRICT — ZONE
S/D t Cj�Q�62, -- MAP
FEE
#�—-- FLOOD ZONE j.r _ ELEV
LOT BLOCK — UNIT SEC TWP 1::�_
TAX ID#
ZONE
-- -- RGE _
GMPP
LOT SIZE/DIMENSIONS_EST COST®�
SET BACKS: FRONT __ REAR _-- SIDE t�S_:,c ,ir, SIDE
SQ FT BUILDING
=CT:
LIVING AREA NACCESSORY _f,,_"F�'.
NAME ' U
PHONE
ADDRESS
CITY
ST ZIP
CONTRACTOR: STATE REG/\CERT # l C,C �5 _ COUNTY CERT
NAME ��t'1�Y1 ice. �` _� ADDRESS -�QL D ` 0,-, PtUe 6 �,C}u
CITY _fit_ ' �'C',C` STATE ZIP c -1- PHONE (_(►
OWNER OF
PROPERTY:
NAME
ADDRESS -�C O)i g L, 9 C Q PHONE _
CITY _ �t 0 STATE ZIP
STATE OF FLORIDA, COUNTY OF ST. LUCIE
Before me, the undersigned authority, personally appear
being duty sworn, deposes and says that the information conta 'e in e
Sworn to and subscribed before me this
Notary Public, St t of Florid at Large
My Commission expire jc'j
07.
Who upon
and correct.
Applicant
® day of
19-0,1Z.
SCHOOL IMPACT FEES
Required [Yes [:]No
Amt. Pd
n..e oA
.5 o !
VIC, vi"N
45'� tj le
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