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DATE FILED: 11 , I-1• 14
REVISION FEE: DO
PERMIT # 3
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
1. LOCATION/SITE
ADDRESS:
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2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: CenC f S 19 &9 3 ST. LUCIE COUNTY CERT. #: Z SS"
BUSINESS NAME: G'r-' o t4
QUALIFIERS NAME: 1✓je, e- PL.crr
ADDRESS• I 40 9:4i Paf P ► ►A-ka-' 0,4- StJ o T o
CITY: W o STATE: FL ZIP: 33 41 }
PHONE (DAYTIME): - 1� -SOO FAX: 4 col - 21 I
4. OWNER/BUILDER INFORMATION:
NAME: 01E�3- P-V E i rt-L
ADDRESS: ( 1 G *r-'-+'ec—) 7-0
CITY: o s'LT -+ 4 Ll� i F J STATE:
PHONE:
5. ARCHITECT/ENGINEER INFORMATION:
NAME: BAeAAH .2 Lyc &-5
ADDRESS: �,4S <,6i4% PAgV-i
CITY: Vi LL
PHONE (DAYTIME): LgD4- 731 - 25:3
Revised 07/22/2014
FAX:
ZIP:
- 6�
L ZIP:
FAX: D -
REVISION