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Form Approved -
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB No. 0710-0003
33 CFR 325. The proponent agency is CECW-CO-R.
Expires: 01-08-2018
The public reporting burden for this collection of information, OMB Control Number 0710-0003, is estimated to average 11 hours per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at whs.mc-alex.esd mbx dd-dod-information-collectionslg mail mil. Respondents should be aware that notwithstanding any other provision of law, no person shall
be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT
RETURN YOUR APPLICATION TO THE ABOVE EMAIL.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act,
Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on this form
will be used in evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and
local government agencies, and the public and may be made available as part of a public notice as required by Federal law. Submission of requested information
is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set of original drawings or good
reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and/or instructions)
and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned.
System of Record Notice (SORN). The information received is entered into our permit tracking database and a SORN has been completed (SORN #A1145b)
and may be accessed at the following website: htt�//d_pcld defense gov/Privacy/SORNslndex/DOD wide SORN Articl View/Article/570115/al 1 45bce acnv
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BY APPLICANn
5. APPLICANTS NAME
8. AUTHORIZED AGENTS NAME AND TITLE (agent is not required)
First - Alex Middle - Last - pamell
First - Bret Middle - Last - Hoskins
Company -
Company - CORE Marine Contractors, Inc.
E-mail Address -
E-mail Address-admin(gcoremci.com
6. APPLICANTS ADDRESS:
9. AGENTS ADDRESS:
Address- 211 Olive Ave
Address- 4370 US Hwy 1
City - Port St Lucie State - FL Zip - Country -USA
City - Vero Beach State - FL Zip - 32967 Country -USA
7. APPLICANTS PHONE NOs. WAREA CODE
10. AGENTS PHONE NOs. WAREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
601-410-8904
772-234-4250 888-858-1492
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, Bret Hoskins to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental information in support of this rmit applica '
6;���
SIGNATURE OF APPLICANT DATE
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
111SIdU (4) r11111gS
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (if applicable)
Man made canal
Address 211 Olive Ave
15. LOCATION OF PROJECT
Latitude: -N 27.329826 Longitude: -W 80019'47.0"
City - Port St Lucie State- FL Zip- 34952
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID 3419-510-0272-000-8 Municipality St. Lucie County
Section - 22 Township - 36S Range - 40E
ENG FORM 4345, MAY 2018 PREVIOUS EDITIONS ARE OBSOLETE. Page 3 of 1