HomeMy WebLinkAboutAPPROVED, REVISION FORMOFFICE USE ONLY:
DATE FILED: --
REVISION FEE:
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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
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: Rx I o W (q ST. LUCIE COUNTY CERT. #: L4
BUSINESS NAME: ploNEm SeizeErA cn. Zl,1c
QUALIFIERS NAME: M 1 e H a eL U E W M a tit
ADDRESS; 16gZ SW 131LTMOR-C ST.
CITY: Porr S-r. Lvc-j STATE: t- _
Fft
PHONE (DAYTIME): '1'72) 340 "�3Q3 FAX: n Z�' 34 9
�yo'`i62C
OWNER/BUILDER INFORMATION:
NAME:
.l+41 V,- t
ADDRESS:
CITY: 7 ' G STATE: ZIP:
PHONE: FAX:
5. ARCHITECT/ENGINEER INFORMATION: k
NAME: Do K11A + Assoc _
ADDRESS: P.O. Box10019
CITY: _ M PA STATE: Ft; ZIP: 336'i
PHONE (DAYTIME): _ �'g j 3) 8? 5- q q 55 FAX:
Revised 07/22/2014