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HomeMy WebLinkAbout2106-0158 REVISON OFFICE USE ONLY: DATE FILED: _____________________________ PERMIT # _______________________________ REVISION FEE: ___________________________ 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 ADDRESS: ___________________________________________________________________________________ ___________________________________________________________________________________ DETAILED DESCRIPTION OF PROJECT REVISIONS: ___________________________________________________________________________________ ___________________________________________________________________________________ CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: ______________________ ST. LUCIE CO CERT. #: ____________ BUSINESS NAME: _________________________________________________________________ QUALIFIERS NAME: ________________________________________________________________ ADDRESS: _______________________________________________________________________ CITY: _______________________ STATE: _______________ ZIP: _______________________ PHONE (DAYTIME): ________________________ FAX: _____________________________ OWNER/BUILDER INFORMATION: NAME: ____________________________________________________________________________ ADDRESS:__________________________________________________________________________ CITY: _____________________________ STATE: __________ ZIP: __________________ PHONE (DAYTIME: ___________________________ FAX: _____________________________ ARCHITECT/ENGINEER INFORMATION: NAME: ____________________________________________________________________________ ADDRESS: _________________________________________________________________________ CITY: _____________________________ STATE: ____________ ZIP: ___________________ PHONE (DAYTIME): ___________________________ FAX: ____________________________ SLCCC: 9/23/09 Revised 06/30/17 2106-0158 4416 Areca Palm Dr .Fort Pierce, FL 34982 RE-ROOF SHINGLE TO SHINGLE WITH GAF WEATHER WATCH UNDERLAYM (NOA: 19-0312.04) (NOA 18-1023.10) SYSTEM E2 (1469 SQ FT) & RE-ROOF FLAT ROOF WITH FIRESTONE - APP 180 - TORCH WHITE (NOA: 20-0818.11) -- (1647 SQ FT) CCC1331450 KNOX SERVICES KOH S KNOX 21301 S TAMIAMI TRL, STE 320, PMB 132 ESTERO FL 33928 239-470-6771 PALINO, MARYANN 4416 ARECA PALM DR. FORT PIERCE FL 34982