HomeMy WebLinkAboutREVISION, Remove framingOFFICE USE ONLY:
DATE FILED: _
REVISION FEE:
PERMIT # 2CC4 ` U0 2D
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:
IOC 51 S 0 785
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
den L
CONTRACTOR INFORMATION:
STATE of FL REWCERT. #: r V�)C_ 025 l 1
BUSINESS NAME: k tC- 1ULyY1
QUALIFIERS NAME: Ct.Ii
ADDRESS:
CITY: rmSTATE: rC..
PHONE (DAYTIME)2L2,` 1-4
OWNERIBUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME:
STATE:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: -6
PHONE (DA
SLCCC.• 9123109
Revised 06130117
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l v\ LAdpC�
ST. LUCIE CO CERT. #:
n'1
FAX:
r IAA.
FAX:
WS
ZIP:
BUILDING & CODE REGULATION DIVISION
5 - 1 = 2300 VIRGINIA AVENUE
Or FORT PIERCE, FL 34982
772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE: 9?,V Y�t
Permit # 2-0D+ C)(o2-0
Credit Card Users: I,5% Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA- MASTERCARD
Credit Card Number � ��[ - 5 50
Expiration Date Zip Code ._54-7
3 digit security code S
Amount $ + 1.5% surcharge
Business Nar
Authorized S
Print Name:
Phone: [� } - OR (�
Fax:
Comments:
SLCPDSD Revised 4/01/2010 EN