HomeMy WebLinkAboutAPPROVED, Revision formOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
PERMIT #
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 y� f
ADDRESS: 7b 3V [i 1 J� W I
PXMct 20ra-0150
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
4"-k d &� Orj r0 �)"Ja rr, owc
Mt'(,(M Un GC rr C na ; � r r.�i o III- d [AIJA .1 nAdflrf
CONTRACTOR INFORMATION:
STATE of FL REG.ICER�. #: ? 3 147
BUSINESS NAME: k I Y? Ii b-v
QUALIFIERS NAME: 1,211 {, /2 0,7 Pl
ADDRESS: 9 5 S_ /<Il I
I UCIE CO CERT. #:
CITY: rf trcle ST TE: FI ZIP:
PHONE (DAYTIME): I? E j( )1,31 FAX:
OWNERISUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME: FAX:
ARCHITECTIENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 061301I7
ZIP:
ZIP: