HomeMy WebLinkAboutAPPROVED, REVISION FORMOFFICE USE ONLY:
DATE FILED: _
REVISION FEE:
COUNTY"ML
1. LOCATION/SITE
ADDRESS:
PERMIT#
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
1?12-- �
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: Rx i i C7 W I q ST. LUCIE COUNTY CERT. #:
BUSINESS NAME: plomc 2 SCizecrtj co - 2'�jC . �
QUALIFIERS NAME: M i e H a C-L rJ E W M A lJ
ADDRESS: 1 fo 8'Z. SW g l LTM 0 2 C sr.
y?63
CITY: Po,cr S?.Luc-it STATE: ZIP: 349 y
PHONE (DAYTIME): 11IM) 340 "Lj3g3 FAX: e7 7?Z340'16ZG
4. OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE:
5. ARCHITECT/ENGINEER INFORMATION:
NAME: DO ;(IAA + Assoc.
ADDRESS: P0. r6ox 10 0 39
CITY: AKl FA STATE: FL ZIP: 336Z
Y PHONE (DAYTIME): � 131 t9 5— 9 9 S5 FAX:
Revised 07/22/2014