HomeMy WebLinkAboutREVISON FOR POLY LINEOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
LOCATION/SITE
ADDRESS:
PERMIT # �: k D 0- - (DOI $.0-
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
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: d D L� 14 ST. LUCIE CO CERT. #: d U 0 1
QUALIFIERS NAME: U-C4-X " 1.-,t-
ADDRESS: "LA S W
CITY\,I e. Vl7 ATE: ZIP: L�
PHONE (DAYTIME): S =VAe \ FAX: SLo I - a CA R
OWNER/BUILDER INFORMATION:
NAME: S �k'l�,.kP�/
ADDRESS: LO'l��i., �-t-t -D
CITY: Yh k STATE: ZIP: 13
PHONE (DAYTIME: "i �� - 3 Z� �-( FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130/17
STATE:
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