HomeMy WebLinkAboutPermit Revision 2004-0660OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
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
LOCATION/SITE
ADDRESS:
65od nn wA 0( IzoL'
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C6CI
BUSINESS NAME: TDw VW)jivv, R
QUALIFIERS NAME: TOVi vi r. D
ADDRESS: 1341 U F"4.nuA
CITY: I UA' ST
PHONE (DAYTI ):
OWNER/BUILDER INFORMATION:
NAME:
CITY:
PHONE (DAYTIME:
e,02* 1O bQ-OVVVj .
ST. LUCIE CO CERT. #:
FL -
FAX:
STATE:
ARCHITECT/ENGINEER INFORMATION: d
NAME: �M yVn VR�a -VP. &V -r,, yl Q QAIAt 3nro 0
ADDRESS: 303 F UdPA,
CITY: ��� jDV) P�qnvrj�, I STATE:
PHONE (D�TIMEI: 01,;z4, Gr I I
SLCCC: 9/23/09
Revised 06/30117
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