HomeMy WebLinkAbout2004-0170 Revision Form 6.30.20OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
LOCATION/SITE
ADDRESS:
PERMIT # _
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
DETAILED DESCRIPTION OF PROJECT
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C. l5-`n-��p
BUSINESS NAME: y- i i/4ni
QUALIFIERS NAME: 0
ADDRESS: L OCA CA
CITY: STATE:
PHONE (DAYTIME): -
OWNER/BUILDER INFORMATION:
NAME: 1 S i M1
ADDRESS:L 4y
CITY: VIA STATE:
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS: '7
CITY:
PHONE (DAYTIME):
SLCCC. 9123109
Revised 06130117
e .r'L
ST. LUCIE CO CERT. #: 31 u —I pig
IZIZ P:
FAX: -
ZIP: Y3 I ,gyp
FAX: