HomeMy WebLinkAboutREVISION; Product ApprovalOFFICE USE ONLY: -
DATE FILED: FF PERMIT # -2 / O 55S - n l 3 O
REVISION FEE:' l� -7 RECEIPT #
PLANNING & DEVELOPMENT SERVI
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: P
/9.50 t3co ksrndf
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
BUSINESSNAME: C- r
QUALIFIERS NAME: Raul Cep $j I jD
ADDRESS: ;M Pa r a- Or i �
ST. LUCIE CO CERT. #:
CITY: P-r+ s f l o J c e- STATE:�-
PHONE (DAYTIME):6,e�l-G8s-.5'3,q/ FAX:
OWNER/BUILDER INFORMATION:
NAME: _
ADDRESS:
CITY:
PHONE (DAYTIME:
STATE:
ARCHITECT/ENGINEER INFORMATION:
I
ZIP: :3 4
ZIP:
NAME: RLyrtm1-U ,�one5
ADDRESS:17'768 IIS t1A We- Jubler-
CITY: STATE: QA ZIP:
PHONE (DAYTIME): rG! -�7R- eid'3! FAX:
SLCCC: 9123109
Revised 06130/17 yy colpy