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HomeMy WebLinkAboutRevisions (2) OFFICE USE ONLY- 1 DATE FILED: PERMIT# 0& O j REVISION FEE: RECEIPT# PLANNING &DEVELOPMENT SERVICES BUILDING&CODE REGULATION DIVISION o 2300 VIRGINIA AVENUE • w, FORT PIERCE,FL 34982-5652 (772)462-1553 FAX(772)462-1578 APPLICATION FOR BUILDING PERMIT REVISIONS PROJECT INFORMATION 1. LOCATION/SITE /� c� 0 `' �i �`cy L �•+ ADDRESS: 2. DETAILED DESCRIPTION OF PROJECT REVISIONS: t VM Z 67A• 3. CONTRACTOR INFORMATION: STATE of FL REG./CERT.#:Ccc 13P7631 ST.LUCIE COUNTY CERT.#: BUSINESS NAME: QUALIFIERS NAME: r A ADDRESS: 117or11 CITY: A/ STATE: ZIP: PHONE(DAYTIME): 707 FAX: 7 VaA� 54 4. OWNER/BUILDER INFORMATION: NAME: N ` p-ma 11R�' ADDRESS: CITY: STATE: a `.'t PHONE 5. ARCHITECT/ENGINEER INFORMATION: NAME: IV ADDRESS: CITY: STATE: ZIP: PHONE(DAYTIME): FAX: Revised 07/22/2014