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DATE FILED: p ]� PERMIT
REVISION FEE: I G RECEIPT#
PLANNING &DEVELOPMENT SERVICES RECEIVED _
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE DEC 16 w!9
FORT PIERCE,FL 34982.5652
(772)462-1553 ST. Lucie County, Permitting
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
sls 1 n liev Wa. F64 emme- 1=t_
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
Chi n q e 7 kW KPak +o 5 Ie-W
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. l q I Q 351 ST. LUCIE CO CERT.#:
BUSINESS NAME: JU5+ ovk' U G
QUALIFIERS NAME: J G mf5 W o use{5
ADDRESS: 5422 IOW Crrnnne_ 5�
CITY: (20-re F LUC)Cl STATE: R, ZIP: '3q q T(o
PHONE(DAYTIME): 7 72.^ 570 -Q 1 19 FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
SLCCC: 9/23/09
Revised 06/30/17 REVISION