HomeMy WebLinkAboutScan 2021-12-23 10.08.38.pdfOFFICE USE ONLY:
DATE FILED:
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
ADDAESS:4
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CE T_
BUSINESS NAME: HaCP, 2D, QC_
QUALIFIERS NAME:
ADD S : � N L&1��rY7
CITY r t G f Lj.LC � e- STATE-.
PHONE (DAYTIME):
OWNER/BUILDER INFORMATION:
NAME: t?n I I 1 &Dh(-)
ST_ LUCIE CO CERT. 9:
a t vd.
ZIP:-�
FAX:
CITY: VQ[n 2SM r� _ STATE: I=(- ZIP:
PHONE (DAYTIlVIE: -5FAX
ARCHITECTIENGINEER INFORMATION:
NAME: -TQ -sh
ADDRESS:_ 00 Ea -A _ n StCITY: �YT STATE: FL_ ZIP:
PHONE (DAYTIME): 7 7,� - c2 Sl- 3G_ FAX:
SLCCC: 9123109
Revised 06130117