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HomeMy WebLinkAboutRevisions OFFICE USE ONLY: �(� DATE FILED: -``a-1'C a PERMIT# NIA -o ct REVISION FEE: '5.00 RECEIPT# PLANNING&DEVELOPMENT SERVICES BUILDING&CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE,FL 34982-5652 (772)462-1553 .' APPLICATION FOR BUILDING PERMIT REVISIONS PROJECT INFORMATION LOCATION/SITE ADDRESS: ,r� S al I d4i--er, (� ki3.1 DETAILED DESCRIPTION OFROJECT REVISIONS• de ..-k:-,6,-,...(4,, ,,,,,,,, ,3 9 6,-. /E) tzee 3.ycito, 6p, r/.�, ' 1 geAl , * 'c- CONTRACTOR INFORMATION: STATE of FL REG./CER #: t� .gec2ST.LUC CO C RT.#: BUSINESS NAME: / J c r .` i ./.4 C;� , / QUALIFIERS NAME: / / • „rid* r', ADDRESS: 1 4'PA. IF4 i CITY: `41 '-'t STATE: ZIP: P- Al" PHONE(DAYTIME): ? fes 4 - FAX: OWNER/BUILDER INFORMATION: NAME: ADDRESS: II CITY: STATE: ZIP: PHONE(DAYTIME: FAX: ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: STATE: ZIP: PHONE(DAYTIME): FAX: SLCCC: 9/23/09 RE s,: Revised 06/30/17 VISI -`• ,i