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RIC`,T DE`VAV PFRIi I APPI ICAU FARM
rrntr r'n><INTY EN('IEERIN .
2300 VIRGI.NA AVENUE) 2� IFLOUR,
I"T.PIERCE,FL 34982 (772)462-1107
Submit via email at: Ri-1lt0_f%_V TPerIIlit-yllacI_11SI.11M7
NAME OF APPLICANT
MAILING ADDRESS ( �7 S' ( ZIP ��`t�f 2—
STATE—
to cam.}.-.
PI30NE NO.
TYPE OF PROJECT(CHECK ONE) ❑UTILITY ❑ COMMERCIAL Iq RESI.DENTLA:L DEVELOPMENT ORDER(other)
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Name of OWNER responsible for facility after installation +il r� L; �r-�;L�_j 1 ; ru e}
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Phone No. - 2 Z
PER�IITTEE'S REPRESENI:AVTY A NLVIOIVIU ®F 2oROURSINISTERING WOF
PRIOR TO COMMENCE ZE T OF WORK.RIGHT-OF-WAY AND
NOTIFYING ST.LUCIE COUNTY _
' �} PHONE NO p
NAME ,(
with a duration.of days. notice required)
Work shall commence on or about '� J�
CONTRACTOR'S NAME t L1 C:',-
M N i-
AILIG ADDRESS _ PHONE N
EMAIL
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As the Applicant,v<re request pennissionunt as ublic aonstruct reas of the(County.Below s a description of the type of work t bents
deeded to or maintained.by St.Lucie County p � � ��� �e Iz
performed in County Right-of-Way and name of County Road: Nit t� \V�,,2 2.
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The following MUST be submitted with an original signed copy of this application:
If 1) Detailed maintenance of traffic plan' professional On En veer will be oequi required to design,si nn and tseal isaid plans.
and/or road closures,a Florida Registered
2) Show on an attached plan(s)(11"x17mPf tile location and
referred to as-IMPROVEIO-IMPROVEMENTS").
je aspect of the work
that will disturb County maintained i p
** This permit and all its attachments must be ke ton the ivork site and rominenthy dis la,ed or be available upon-re guest
G�-1 .tA.s Title U �N C'_t•-- /'
Applicant/0"mer t��Er. � t �v��H1
i��kE 1t i -
Dat
By: e '_tiZ2 -D Email/Phone: fi�'Y_J
pro y this pennit, 1 agree to comply Ninth the "GENERAL AND SPECIAL
By p with installation of work covered b
CONDITIONS OF THE RIGHT-OF-WAY PERMIT"' OFFICE USE ONLY
RIGI-IT-OF-WAY DESCRIPTION:
REVIEWED BY ACQUISITIONS DIVISION
DATE
The aforestated installation is hereby permitted under the following provisions:
BOARD OF COUNTY ComMISIONERS,ST.LUCIE COUNTY,FLORIDA
BY DATJ_
R/W PERMIT NO 020-101
County Engineer-Representative
Rev.8-3-18