HomeMy WebLinkAboutZoning Compliance/Use Permit OFFICE USE ONLY: DATE FILED: `" PERMIT#:
PLANNING&DEVELOPMENT SERVICES
f' X x $+ ; BUILDING&CODE REGULATIONS DIVISION
COUN T 2300 Virginia Avenue
0 . A Ft.Pierce,FL 34982-5652
772-462-1553 Fax 772-462-1578
APPLICATION FOR TEMPORARY USE PERMIT
BUSINESS NAME:
NAME OF EVENT:
LOCATION AND ADDRESS OF TEMPORY USE EVE
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PROPERTY TAX IDENTIFICATION#:
DESCRIPTION OF TEMPORARY USE: QAil �4was
DATES OF THE EVENT:_ _1 CX . 3 — \J eC_
APPLICANT'S NAME: e�pYc,-
APPLICANT'S STREET ADDRESS: 4D(. ) l e� e_�sS 7;�'�.
CITY: ��.��e`CCA STATE: a ZIP CODE::
AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZES
TO HOLD A TENMR"y USE EVENT.
PROPERTY TAX IDENTIFICATION
LEGAL DESCRIPTION OF PROPERTY.
PROPERTY AmREss- 14SQ2- La- 42 9
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MOPERTYOWMIPSNAME-
UP CODE.
CITY. r, STATE:
PRINT OWNER'S NAME
STATE 019, Y>d LINTY OF
ACI(NOWLUMM MOM MR THIS DAY OF 211
By _WHO ISPERSONALLY KNOWN TOM1EY�--
ASIENICATION.
OB PRODUCED
MGNA`n=OF NOTARY TYPIR OR PRINT MW 019 NOTARY
TnU- NOTARY PUBLIC CO ION NUMMIL
COMMONWEALTH Of PENNSYLVANIA
NOTARIAL SEAL
THERESA M SUSCO
Notary Public
LOWER MERTON TWP MONTGOMERY COUNTY
MY Commission Expires Jan 20,2019
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