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DATE FILED: I - PERMIT#
REVISION FEE: RECEIPT#
I 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:
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DETAILED DES. OF PROJECT
VISIONS:
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CONTRACTOR INFORMATION: /
STATE of FL REG./CERT. #: G/y)G 635 y a I ST. LUCIE CO CERT.
BUSINESS NAME: SC2ctCC3g.S-�
QUALIFIERS NAME: 6h �-c; U
ADDRESS: 310 �s r; 1 315
CITY: r0 rk'O Q/`(e- STATE: ZIP: } .�
PHONE (DAYTIME): -770 - y6ul-25/00 FAX: 7 77
OWNER//BUILDER INFORMATION:
NAME: M,'G W1 gQclov
ADDRESS: q l Sov.QrQ, (,Jc� -
CITY: / ,N.SGAj /T:5 4 iU TATE: ri ZIP: 3 9
PHONE(DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
SLCCC: 9/23/09
Revised 06/30/17
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