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DATE FILED: cis l 11 PERMIT# -I(-)q — 0-3o a
REVISION FEE: RECEIPT# 00Q0 155-'),)C2, _
PLANNING&DEVELOPMENT SERVI -
BUILDING&CODE REGULATION DIVISIC N RECEIVeD
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 DEC 0 9 2019
(772)462-1553
ST. Lucie County, Permitting
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE I
ADDRESS: S ` I t
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DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. L.t3 ST. LUCIE CO CERT. #: a 1133-3
BUSINESS NAME: �Aa+LIQ
QUALIFIERS NAME:
ADDRESS: 1010 N( m tis a
CITY: F+.'; ,ter P STATE: F I. ZIP: 3 LI9$ -)-,
PHONE(DAYTIME): �-1 L o I-$.�a 8 FAX: 461-L4695
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME):
SLCCC: 9/23/09
Revised 06/30/17 REVISION
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