HomeMy WebLinkAboutRevision; Replace All Roof ShinglesOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DMSION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5652
(772)462.1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
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DETAILED DESCRIPTION OF
RFVISIONSc
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: G le
BUSINESS NAME: _1�jeA)1( Axrl
QUALIFIERS NAME:
ADDRESS: Z 574;
CITY: —ILt�-qV, C fi4 S A
PHONE (DAYTIME): /• �"
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMA
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
Z:m•
File Copy
ST. LUCIE CO CERT. #:
.Y'
_ ZIP:
FAX:
STATE:
FAX:
TION:
ZIP:
STATE: ZIP:
FAX`
SLCCC: 9123109
Revised 06/30/17
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DESIGN & FORENSICS, INC.
725 SE PORT SAINT LUCIE BLVD.
SUITE 203
PORT SAINT LUCIE FL 34984
(772) 2 8 5 - 0 5 7 2
BRIAN L MAS KOL
FL PE # 66080
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DATE
DESIGNED
GMR,
08-10-19
DRAWN
GMW
08-10-19
CHECKED
JOB NO.
2019-239