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DATE FILED: 1 01' PERMIT# ' 7 (� ! JD
REVISION FEE: 00 RECEIPT#
PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE OCT 13 2020
FORT PIERCE,FL 34982.5652 St.Lucie County
(772)462-1553 Permitting
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
D a
3 A 9,51
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: ST. LUCIE CO CERT. 9:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: a , i�(C_f, , I STATE: �L ZIP: 3Aa S t
PHONE(DAYTIME: 171 a - - d$- 40?1 FAX: t'j A
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): FAX:
i
SLCCC: 9123109
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RECEIVED
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! OCT 13 2020 I
St.Lucie County j
Permitting
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