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APPLICATION FOR PERMIT PERMITION
OFFICE USE ONLY: DATE FILED: PERMIT# 2107-0292 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: 1426 North 35th St Fort Pierce,FL 34947 DETAILED DESCRIPTION OF PROJECT REVISIONS: Layout Change CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: EC13008056 ST. LUCIE CO CERT. #: BUSINESS NAME: Freedom Forever Florida LLC QUALIFIERS NAME: Greg Albright ADDRESS: 3590 NW 54 ST CITY: Fort Lauderdale STATE: FL ZIP: 33309 PHONE (DAYTIME): 951-404-0837 FAX: OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME: FAX: ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): FAX: SLCCC: 9123109 Revised 06130/17