HomeMy WebLinkAboutApplication for Electrical Permit`l35 P02
MASTER PERMIT: I >_Oi b'00
PERMIT NUMBER:„ 0I
r
ST. I.UC1E COUNTY 4
DEPARTMENT OF COMMUNITY DEVELOPMENT
2300 VIRGDO AVENUE
FORT PIERCE, FL 91002-560
561-462.1653
� > ,A.PPLICA►.TION FOR
ELECTRICAL PERMIT
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1. LOCATION/SITE ADDRESS: �;;��LS - � H.
DATE:
2. PARCEL ID NUMSER: / 3 -60Jill
SECT 3 TWP 3s RHO 3 % MAP 3 3 zNG LU INIi 1
3. DESCRIPTION OF PROJECT OR WORK ACTIVITY:
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4. OWNERS INFORMATION 5. CONTRACTORS INFORMATION
Name: !"LO�Cr• *j1eL.� FI. REGICERT R: OD 1
Address: _ COUNTY CERT A:
Co' . SIIz Business Name: F�
6. 'VALUE OF CONSTRUCTION! S FEES -DUE; ; %• t�
NOTE: A 4E►ABATE PERMIT IS REQUIRED FOR A TEMPORARY POLE. ItECEf•
OWNEWS AFFIDAVIT: 1 certify (hat all of the information contained in this application Is an I b rnplaneo
®tl a plieabte• w iinp n.str�u�io`n, and Zonlnp.
T=
PRINT QUALIFIERWOWNEAApS (NAME !d TNR • - QUAtif/&R/OW ER
STATE OF FLORIDA, COUNTY p��.,}�
THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS DAY Q ,� tiIIL�yI�.,
G IS TO ME OR WHO HAS PRODUCED
- - AS IP'ioN.
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SIONATUR$ OF P ME 01 NOTARY HeIvy PO a Florida
NOTARY PUUfg TITLE � COMMISSION NUMBER 1'iOlfYf is
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY R$SULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY, IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR
AN ATTORNEY BEFORE RF-COR61140 YOUR NOTICE OF COMMENCEMENT. '
024 P03 ,