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DATE FILED: PERMIT# v`20 C) ( — 2 0 1 (o
REVISION FEE: RECEIPT#
PLANNING&DEVELOPMENT SERVICES
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 RECEIVED
(772)462-1553 JUN 2.5 1010
APPLICATION FOR BUILDING PERMIT REVISIONS Permitting Department
PROJECT INFORMATION St. Lucie county.
LOCATION/SITE
ADDRESS:
� (f 7�) e oA 0 0 C)
FL-
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: ST.LUCIE CO CERT.#:
BUSINESS NAME: V •T u�r i c� S �� -'►'S , �✓
QUALIFIERS NAME: o, s
ADDRESS: a
CITY: - ,Z, STAT : ZIP: 3 C�C\ S)
PHONE(DAYTIME): FAX: `7 7 Z - 7�14- 1-S- V
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS: 3 K),`
CITY: cSZ STATE: J-w ZIP:- '3
PHONE(DAYTIME: -70 - 1 j -3 I �j FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
SLCCC: 9123109
Revised 06130/17