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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
ADDRESS:
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U-c-)e F C. _ 149 � Z
DETAILED DESCRIPTION OF PROJECT
REVISIONS: nn _I n
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
ST. LUCIE CO CERT. #: J) Y 13
BUSINESS NAME: (,one L)nku_hcg
QUALIFIERS NAME: G>
ADDRESS: :54r 5- U S fi- v i1 -0- Z3 Z
CITY: ? SL STATE: FL ZIP: 3 (4S S Z
PHONE (DAYTIME): 7 -7a'- - &U-) - Z�& l I FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS: 2-pj7 Sc- No-N R[c.-kL e(f Dom.
CITY: '?JL STATE: fyL ZIP: 3 Y S Sz.
PHONE (DAYTIME: -7-7a1 -y0 `7- U ff FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: A rch 1 }--eLkon�c I n(
ADDRESS: 9'0(o ne-L. 4, e Awe
CITY: 01.e-re STATE: -PL.
PHONE (DAYTIME): FAX: _
SLCCC. 9123109
Revised 06130/17
ZIP: 2l4- S0
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