HomeMy WebLinkAboutRevisions OFFICE USE ONLY: Q
DATE FILED: l I / l n 7 PERMIT# 7 O 1
REVISION FEE: 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:
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: ST. LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
OWNER/BUILDER INFORMATION:
NAME: Li-Al
ADDRESS: 2
CITY: p.c rce- STATE: r16r rti ZIP: . 3
f PHONE(DAYTIME:772 011 3 1$'7 FAX:
i
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
SLCCC: 9123109
Revised 06130117
WIYNJOW
Cor\crP4G 44e)
Wes}
njow
say -
n n 3'. WOQ sorews
COnGrG-�e �;/1+� •�X6 ITT FrannI'ng • 2 loyerS 30)6
2X 6 •2X 6' PT (en4er Fro,M,n '1 ! h�i rE Lc,4)\
.S SF e� .0 on Gen�er Sc.n44 S4t cc,6
skel coSle brace on C%ll rful"ns anglers
Tc.ecanS SPAS 6 vn,ce—(4er'
36nv
kFILE
zu
OWNER-CONTRACTOR AFFIDAVIT
RE:SCOPE OF WORK FOR PERMIT# P I l _b I l a
ADDITION OF WALL INFILL DETAIL AND WORK
I, MARK LIEBL, OWNER-CONTRACTOR FOR THE WORK PERFORMED AT MY HOME LOCATED AT 7202
HIBUSCUS ROAD, FT. PIERCE, FL., DO HEREBY CERTIFY THAT THE WINDOW WALL INFILL WORK WAS
PERFORMED BY ME IN STRICT ACCORDANCE TO THE INFILL DETAIL SUBMITTED BY ME DATED 11-12-19.
I
CERTIFIED AND SWORN.BY MY THIS DAY OF NOVEMBER,2019.
MARK LIEBL, HOMEOWNER, OWNER-CONTRACTOR � 4c.
Copy