HomeMy WebLinkAboutRevisions pppp-
OFFICE USE ONLY:
DATE FILED: a� PERMIT# 11 4- - d dq I
17
i
REVISION FEE: S' d RECEIPT a
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:
h
U
DETAILED DESCRIPTION OF PROJECT ,,
REVISIONS: (��" � Y oovl&S
CONTRACTOR INFORMATION::
STATE of FL REG./CERT. #: �`C� l ST. LUCIE CO CERT. #:
BUSINESS NAME: Y`ti4� oia
QUALIFIERS NAME:
ADDRESS: C,�--
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX: 6
OWNER/BUILDER INFORMATION:
NAME: L C
ADDRESS: '0 c�
CITY: STATE: ZIP:
PHONE (DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: ✓ 0 1
ADDRESS: 4300
CITY: I STATE: ZIP:
PHONE (DAYTIME):M FAX:
SLCCC: 9123109
Revised 06130/17
^7 E�.5,�4i