HomeMy WebLinkAboutRevision Application for Building Permit OFFICE USE ONLY:
DATE FILED: J ' PERMIT# l l 2 :2 - ® Z 44�1 /
REVISION FEE: .RECEIPT#
#. ST.LUCIE COUNTY
" P LIC WORKS DEPARTMENT N�c
ODE COMPLIANCE DIVISION
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2300 VIRGINIA AVENUE
ORT PIERCE FL 34982-5652 s G
(772)462-1553 . le 6
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�� q P ICATION FOR BUILDING PERMIT REVIS ONS
PROJECT INFORMATION
1. LOCATION/SITE
ADDRESS: _
2:M 3 2— W r+TE ,✓6 t)Jd4 y FOR/
X' .2. DETAILED DESCRIPTION OF PROJECT-
'REVISIONS:
3. CONTRACTOR INFORMATION:
'ST.of FL REGJCERT.# jW V,15 36 6,�b ST.LUCIE CTY.CERT.#.
BUSINESS NAME: O ,t' 5 d _ C'O S i
QUALIFIERS NAME: AIA P_; 8
ADDRESS: .6
CITY: STATE: ZIP: 7
PHONE(DAYTIME): -'??Z -Z)!q-Z/ SO FAX: ` 7-O z
4. OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
i CITY: STATE: ZIP:
PHONE/CELL: FAX:
5. r'ARCHITECT/ENGINEER.INFORMATION: _
!NAME:
... ADDRESS:
CITY: d�" STATE: ZIP: a—
"�r PHONE(DAYTIME): (�/ Q//`7 da g FAX: