HomeMy WebLinkAboutRevisions OFFICE USE ON
DATE FILED: . aC) PERMIT#
REVISION FEE: RECEIPT# !
PLANNING&DEVELOPMENT SERVICES
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
_ FORT PIERCE,FL 34982-5652
(772)462-1553 FAX(772)462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
1. LOCATION/SITE \ s ( of ,
ADDRESS: v V v
I
2. DETAILED DESCRIPTION OF PROJECT 1 J
RE IONS: rt,
/ Cg,
g&il to Orcjto-pare'
ve, 2L -e--1
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: ST.LUCIE COUNTY CERT.#:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
I
4. OWNER/BUILDER INFORMATION:
NAME: k2 Y o
ADDRESS: I Q&&Yi 1
CITY: STATE:
ELL_, ZIP:
PHONE: L� FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
Revised 07/22/2014