HomeMy WebLinkAboutRevisions OFFICE USE ONLY:
DATE FILED: rI PERMIT#
REVISION FEE: RECEIPT#
. - - PLANNING & DEVELOPMENT SERVICES '" r Ems'r
COUNTY BUILDING&CODE REGULATION DIVISION
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2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 DEC 2 Q 2017
(772)462-1553 FAX(772)462-1578
PE R'•811'TI NG
APPLICATION FOR BUILDING PERMIT REVISIOMPt. Lucie County, FL
PROJECT INFORMATION
1. LOCATION/SITE dam' � .\j� \` �p� �
ADDRESS: S. / ,�/
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: C,�C 6 o L/ ST.LUCIE COUNTY CERT.#:
BUSINESS NAME: ia.1/ ,Qyi / Dz kC S
QUALIFIERS NAME: r� v
ADDRESS: (,v vG ,
CITY: T STATE: ZIP: ,rj
PHONE(DAYTIME): /— FAX:
4. OWNER/BUILDER,,INFORMATION:
NAME: L CO 6 I v i
ADDRESS:
CITY: -r v STATE: f-- . ZIP:
PHONE: p FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
Revised 07/22/2014
DEC 2 0 2017
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St. Lucie County, FL
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