HomeMy WebLinkAboutAPPROVED ,revisionOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
LOCATION/SITE
ADDRESS; �
PERMIT#.7 1 ( 009 _
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
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DETAILED DESCRIPTION OF PROJECT
REVISIONS: _
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: , ST. LUCIE CO CERT. #:
BUSINESS NAME: " &Vj 1,r rngjtE fs
QUALIFIERS NAME:�w
ADDRESS: r
CITY: 95L STATE: 1 ZIP:
PHONE (DAYTIME): ?7,2 ,3,13,- 73 7 FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS: SS la"t
CITY: r
PHONp
DAYTIME:
S"1'AfiE: I ZIP.
FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: •
ADDRESS: ra. l .a R
CITY: "(r_ STATE:
PHONE (DAYTIME): -CLI) 1.3o -rC5 3y FAX:
SLCCC., 9123109
Revised 06130117
ZIP: