HomeMy WebLinkAboutReivision FormOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
LOCATION/SITE
PERMIT # I LI L - 044- q .
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BURRING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
ADDRESS:
5-,5I a 101ne tree orl&fe
fr p,Go-re 34-9V2-
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
(Zeylglon) 09 Enejy calc:.u�Cc�lon5
CONTRACTOR INFORMATION:
STATE of FL REG/CERT. #: C-AC I $l 6 - -1!Z ST. LUCIE CO CERT. #: 2 6 ¢
BUSINESS NAME: 5 m 1 dat 13 C-oo h n q mid I n L
QUALIFIERS NAME: Td-Mes 5 ny Clel -
ADDRESS: P. 0. SOX 2007
CITY: FT Pierce STATE: ZIP:.3 ¢ q 5,4-
PHONE (DAYTR%4E): 7 7 Z 5 28 3 3 7 7 FAX -7 7 Z. - Coo -4, $ l/
OWNER/BUILDER INFORMATION:
NAME: G-arao-d M ead
ADDRESS: S' S) q rlf)e tre p 00-1 ve
CITY: r. e I e'*-cC STATE: F L ZIP:
PHONE (DAYTIldF: 15(D / 2 g) q(o l S FAX: r
ARCHITECT/ENGINEER INFORMATION:
NAME: MiGha,eI H.,
ADDRESS: !go b ocl a
CITY: _r , P)BrY�
PHONE (DAYTIME): '77'L. 4 6 o
SLCCC: 9123109
Revised 06130117
STATE: Y! ZIP: 3 4 4S0
5/ FAX: 77Z 4-60 4Z 44