HomeMy WebLinkAbout11.23.20 REVISION APPLICATION OFFICE USE ONLY:
DATE FILED: PERNT#
REVISION FEE: RECEIPT#
PLANNING&DEVELOPMENT SERVICES
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982.5552
(772)452-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATIONISITE
ADDRESS:
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: b D LA3 LA ST.LUCIE CO CERT.#:
BUSINESS NAME:
QUALIFIERS NAME: V Y A ( A s
ADDRESS: 4 D ) 0 Piy �
CITY: -r-� Q Ilk l2 STATE:_ ZIP: h �2
PHONE(DAYTIME):)`) t - LA FAX: L- S Lp 1 - 6
OWNER/BUILDER INFORMATION:
NAME: N�Wm &'p- 0 .r.✓ V W!�/1
ADDRESS: --1 )-0 LP etl,, 0�
CITY: '% Y-T 01LL%A STATE: ZIP: �{ r
PHONE{DAYTIME:'n t,- LA Y' A v FAX:
ARCMTECT/ENGINEER INFORMATION:
NAME:
ADDRESS_:
CITY: STATE: ZIP:
PHONE (DAYTIME): FAX:
SLCCC: 9123109
Revised 06130117