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Permit Revision Form (Civil and Truss)
OFFICE USE ONLY: DATE FILED: _____________________________ PERMIT # _______________________________ REVISION FEE: ___________________________ 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: ___________________________________________________________________________________ ___________________________________________________________________________________ DETAILED DESCRIPTION OF PROJECT REVISIONS: ___________________________________________________________________________________ ___________________________________________________________________________________ CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: ______________________ ST. LUCIE CO CERT. #: ____________ BUSINESS NAME: _________________________________________________________________ QUALIFIERS NAME: ________________________________________________________________ ADDRESS: _______________________________________________________________________ CITY: _______________________ STATE: _______________ ZIP: _______________________ PHONE (DAYTIME): ________________________ FAX: _____________________________ OWNER/BUILDER INFORMATION: NAME: ____________________________________________________________________________ ADDRESS:__________________________________________________________________________ CITY: _____________________________ STATE: __________ ZIP: __________________ PHONE (DAYTIME: ___________________________ FAX: _____________________________ ARCHITECT/ENGINEER INFORMATION: NAME: ____________________________________________________________________________ ADDRESS: _________________________________________________________________________ CITY: _____________________________ STATE: ____________ ZIP: ___________________ PHONE (DAYTIME): ___________________________ FAX: ____________________________ SLCCC: 9/23/09 Revised 06/30/17 8/3/2020 SLC 2020-0084 4451 St. Lucie Blve Fort Pierce, FL 34946 Civil drawing revisions (Cover Sheet, Sheet 5 of 12, Sheet 6 of 12 and sheet 7 of 12). Revised roof trusses layout and engineering GC1522209 Proctor Construction Company, LLC Rick MacDonald 2050 US 1, Suite 200 Vero Beac FL 32960 772-234-8164 772-234-8188 A-1 Truss Supply 4451 St. Lucie Blvd Fort Pierce FL 34946 772-409-1010 772-409-1015 EDC Engineering 10250 SW Village Parkway, Suite 201 Port St. Lucie FL 34987 772-462-2455