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HomeMy WebLinkAbout5149 WATER LILLY REVISIONS 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 2110-0641 5149 WATER LILLY WAY FORT PIERCE DUE TO MATERIAL SHORTAGE THE UNDERLAYMENT ON THE PERMIT IS GULF EAGLE UNDERLAYMENT INSTALLED IS RHINO U20 FL-15216-R10 CCC1331063 G&A CERTIFIED SOUTH ANDREW AFONG 11951 INTERNATIONAL DR ORLANDO FL 32821 4075401401 MICHELLE JABETH 5149 WATER LILLY WAY FORT PIERCE FL 34981 772- 971-9444