HomeMy WebLinkAboutAPPLICATION FOR PERMIT REVISIONSOFFICE USE ONLY:
DATE FILED: 0 G 6L f
REVISION FEE:
PERMIT #
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:
'ciao-o- ,n Q0 f7T Vler-.-c f U
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
9,5 '
STATE of FL REG./CERT. 9: Gi C o 5 (o(3) ST. LUCIE CO CERT. #:
BUSINESS NAME: ox) i a v, 5 �,
QUALIFIERS NAME:
ADDRESS: I t U �;a, , ((_��co c) (-4y-c
CITY: -e rc c- STATE: r L. - ZIP:
PHONE (DAYTIME):`l'FAX:
OWNER/BUILDER INFORMATION:
NAME: mCk T- 1G%Z-
ADDRESS. `7 aQ .5 �7 t-
CITY: e STATE: F, L ZIP:
PHONE (DAYTIME::] Q ���?� _ FAX:
ARCH ITECTIENGINEER INFORMATION:
NAME: -:Soh r1%
ADDRESS: 5. 0
CITY: (4 �. ��mot
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130/17
_ STATE
Fj-., ZIP:
FAX: