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DATE FILED: ! PERMIT#
REVISION FEE: �J • !9 C9 • RECEIPT# 1
PLANNING&DEVELOPMENT SERVICES
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982.5652
(772)462.1553
APPLICATION FOR BUILDING PERMIftN
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: GCG%32 ,673 7 ST. LUCIE CO CERT.
BUSINESS NAME: 69 A-,' 1,
QUALIFIERS NAME: .✓��-?E= ten,:� z
ADDRESS: t 3 �. w �i7�•-y7%y� �v
CITY: /cam e;'j z STATE: r L ZIP: 4 `�
PHO (DAYTIME): FAX:
OWNER/BUILDER INFORMATION:
NAME: !L ,ei
ADDRESS: o -rc i*7z Tli4 4'
CITY: 4 rL .r STATE: 6-/4 ZIP:
PHONE(DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: ZIP:
PHONE(DAYTIME): ST.LUCIE COUNTY
BUILDING DIVISION sm ARM-FA
REVIEWED ' ff 217"ED
FOR C6jt B
RIN4. V
SLCCC: 9/23/09 REVIEWED BY (�/
DATE
Revised 06/30/17 PLANS AND PERMI MAR 2 6 2019
MUST BE KEPT ON JOB OR
NO INSPECTION WILL BE MADE Permitting Department
St. Lucie County, FL