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ST. LUCIE COUNTY FIRE DISTRICT
FIRE SAFETY PERMIT APPLICATION
2400 Rhode Island Avenue
Fort Pierce, Florida 34950
Telephone 772-462-8306
Fax:772-462-8466
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Make Fees Payable to: Saint Lucie County Fire District
Type of Request: Plan Review ( ) Site Plan ( ) Fire Alarm System
( )Fire Sprinkler System ( ) Fixed Fire Protection System
( ) Fuel Storage/Dispensers ( ) LP Gas Storage/Dispenser
( ) Fireworks Display/Sale ( ) Tent/s ( ) Permit Renewal
( ) Other
Proiect Name: Rwltvcic t S LIB Co m meree
Address: Correr AI 6 off' .Indus e li ,/ 93 rc4Xve- AIVO .Si• �Krie /mac%
City: /L 7� : t e rG e State: L
Owner Information:
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Name: t. C �� Zr/ll [� �S ,Ch d , L kc
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Address: 1,335 /
Zip: 33isv
City: AAA State: ec Zip:
Telephone:
Contractor Information::
Company Name: / / M C /- et. k7(- C
Qualifier:
State License # C G, r
County/City License # � a 06L
_ 1 c�
Address: 1335 A�74Unc Dr,
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City: &h /&ge) beacc l State: ),:V— zip: �r%2
Telephone: 7,3% 366 %
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Fax: ( 73o0- 0,0
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Valuation of Work: 3, 6�8, DD 0, 00
Contractor Affidavit: Applic
installations as indicated. I ce
issuance of a permit.
In consideration of granting of
perform the work and installat
Codes, the Standard Building
revisions after the issuance of
jurisdiction.
THE FLORIDA FIRE PRE
ENFORCED.
Contractor Signature:
( ) Approved ( )Rejected
Comments:
Permit #
Permit Fee:
tion is hereby made to obtain a permit to do the work and
ify that no work or installation has commenced prior to the
this requested permit, I do hereby agree that I will, in all respects,
on in accordance with the approved plans, the applicable N.F.P.A
;ode, the State Fire Marshal Rules, and Local Fire Codes. Plan
he permit is subject to approval by the authority having.
CODE, 2004 EDITION IS CURRENTLY
d
Office Use Only
Date: 7" 3D - aOC
Signature: Date:
1101105