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r � ST. L�JCfE COUNTY PERMIT APPLICATION
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PERMIT NO. ( CODE
APPLI iATION FOR PERMIT TO CONSTRU T '. , / s M
JOB L VOCATION/ADDRESS.]J�(�
�EGAD DESCRIPTION �c� (f // e:I
ROADIIIMPACT: DISTRICT
S/D
III
LOT r--1,-
ROPEIRD
TY
BLOCK
ID � S _ro - -
ZONE
eZ', S AGE PERMIT.,W
(O Wn'0- &
L7 64- z1,09 Kos i Ka��-(
MAP # _
UNIT
r6W o'i -
FEE 7
1/
FLOOD ZONE �1� ELEV
RGE
ZONE GMPP
IMENSIONS 3' N1q
lEO
/7!% x 7 ESQ COST
FN;f�;�f�`JREAR -�� ( ��� SIDE
SQ FT ]BUILDING: LIVING AREA ACCESSORY S.D=2rT
ARCH[ ECT: NAME PHONE _
I
ADDRESS CITY SST ZIP
I
CONT C S TE REG# ��LZ(? "7 r _ COUNTY CERT #• 37 �S
V�
j NAME /2di /C0 //y C�
ADDRESS 0607ffE' �
CITY ! C;l�CG? STATE T /'q ZIP ��7 PHONE
OWNER OF NAME ' '0,'?/-DA PeWC—,e 117J CO
PRO0ERTY: Q `
DDRESS P 8ax �� PHONE
CITY UC IS S C N 9EA G/-i F1.4
ul STATE ZIP 3qg5,, � %oi
STATE OF FLORIDA, COUNTY OF ST. LUCIE
Before me, the undersigned authority, personally appeared ,who upon
being Iluly sworn, deposes and says that the information co ed in the for ng pplication is true and correct.I
G II �•� 1 I 1 X] pplicant
Pirworn to and subscribed before me this day of
Public, State of Florida at Large
Commission expires:
SCHOOL IMPACT FEES
Required ❑ Yes ❑ No
Amt. Pd
Date I'd
Posted