HomeMy WebLinkAboutRevisions Oct, 9. 2019 9 59A No, 0939 P. 1
OFFICE USE ONLY:
DATE FILED: — �� PEkt�IIT# Va-'3 --
REVISION FEE: RE,C)'DIP #
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:
loll N r.�-
S� "C` /'/V F6
leerm 11 f � q10 — 0/&
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
G a N ;nr U l o
CONTRACTOR INFOMIA.TION: p
STATE of FL REG./CERT.#, G 6(3 3S ST,LUCIE CO CERT.#:
BUSINESS NAME; -req c,n aS /
QUALIFIERS NAME: G r.- h r-
ADDRESS: 3 l D
CITY: 4-'7dr-77'A0"Ce_ STATE: 1--4 ZIP: 3
PHONE(DA.YTZME). -7;77- Gf/-X,4-"a0 FAX: 2 y
OWNER/BUILDER INFORMATION:
NAME: �`li'1 arc)c 03 �O
ADDRESS:- d
CITY: e PSL STATE: /f6 ZIP: 9 S
PHONE(DAYTIME: ?7- —3 FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS,
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
SLCCC.9/23/09
Revised 06/30/17