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PERMIT NUMBER:
a ST. LUCIE COUNTY
49 DEPARTMENT OF COMMUNITY DEVELOPMENT
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APPLICATION FOR
ELECTRICAL PERIMT
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t LOCATION/SITE ADDRESS:
2. PARCEL ID NUMBER:
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& DESCRIPTION OF PROJECT OR WORK ACTIVITY:
4. OWNERS INFORMATION
Nrm: LuuP . 01)U41 ( ilpi)
Addrem:
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Phone: zip: 3T
DATE: 1 / 7 d /
6. CONTRACTORS INFORMATION
FL REQICE TT /: _ X: C 0 U rr i l- f
COUNTY CERT r: / 0 J-3 s/
Busimm Nwn.: 1�/L/�,vi o ,✓✓J LSL LrG�
6. VALUE OF CONSTRUCTION:FEES DUE:
HOM A sEaaaATu oaa�� ' FOR-
RECEIPT: .0 1 3 3 Z 2
OWNER'S AFFIDAVIT: 10 OW
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PRINT NAME SIGNMTURE OF QWLLIFIEirOWNER
STATE OF FLOFWA COUNTY OF /' Ltc f&-
THE FOREGOING kNSTAUMg� WAS AcmmmGED BEFORE ME THIS _L.L�.. DAY OF , � 40
90+
(O l Y MOWN TO ME OR WHO W1S PRODUCED AS IDENTIFICATION.
p�\J Sharon MWdron
SW NATURE OF NOTARY TYPE OR f :. �T>�10003
NOTARY PUBL� TITLE OMrMUMBER
tlantle Bonding Co., lno.
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAVI FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
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