HomeMy WebLinkAboutRevisionOFFICE USE ONLY:
DATE FILED: ,� • 2, PERMIT # _
REVISION FEE: Q %t— - I —_ RECEIPT #
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PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
laupauad m.IS FORT PIERCE, FL 34982-5652
`"Q0 (772) 462-1553
APPLICATION FOR BUILDING PERMIT R S ' x
Q��30All PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
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DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION: FILE C®P
STATE of FL REG./CERT. #: C (-C lS D'j 6 `% � ST. LUCIE CO CERT. #:
BUSINESS NAME: � O , G� Z)a s R r 0 J
QUALIFIERS NAME:I �1�E /��9fJLSt�`l�lz
ADDRESS: l3 7
CITY: f a ZT s� I, J c C +t STATE: L. ZIP: 3 4 9 1 -J
PHONE (DAYTIME): 772 - S30 - 7870 FAX:
OWNER/BUILDER INFORMATION:
NAME: Dho/zLLx- 4 C.. U Kli
ADDRESS:. .T4-)] .7T,47,-,L7 6&Ka
CITY: ):�Y ram t'A
PHONE (DAYTIME:
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STATE:
ARCHITECT/ENGINEER INFORMATION:
NAME• PA') k Lo it L c#
ADDRESS: 081 S,lb- V
CITY: ppR d
PHONE (DA TIME): 7 8s - 70 8 8
SLCCC. 9123109
Revised 06130117
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FAX:
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STATE: is L ZIP:
FAX:
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