HomeMy WebLinkAboutrevision formOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
PER.'1i1Tq .ILC 2CO5 - "'-
RECEIPT It
PLANNING & DEVELOPi1IENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS: _
7601 F�orf Wo 14 -or, give. Fort P;erce l FL 3ti Q51
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C V C5 -6q 75
BUSINESS NAME: un ,bj E h rl
QUALIFIERS NAME: O i w i
ADDRESS: ?575 King pointe [� 9
CITY: 0A C YN&,o STATE:
PHONE (DAYTIME): 21 �53 9 3338
OWNER/BUILDER INFORMATION:
NAME: CC' (•v� r7 I'�C)C:1 ► ucc
ADDRESS: -7( G PO VC
CITY: ^F& '�%e CCE STATE:
PHONE (DAYTIME: 7 ~] 2 y53 06 9 y
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
S1.CCC: 9/23/09
Revised 06/30/17
STATE:
ST. LUCIE CO CERT. #:
Inc
✓' 1'�--
uAe. 04
-L ZIP:
FAX: X0`7 �U 2
ZIP:
FAX:
ZIP:
FAX:
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