HomeMy WebLinkAboutApplication For Building PermitOFFICE USE ONLY:
DATE FILED: N
REVISION FEE:
1.
04,
3.
4.
a., D APR 2- 6,204
PERMIT# "A
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION.
2300 VHiGINIA AVENUE
FORT PIERCE; FL 34982-5652
(772)462-1553 -
APPLICATION FOR BUILDING PERMIT &EA4818N&
PROJECT INFORMATION
DETAILED DESCRIPTION OF PROJECT
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. ST. LUCIE COUNTY CERT. #:
BUSINESS NAME: Q,-VcN5-\ gz�l
QUALIFIERS NAME: —te-rS� cA\,p— \r\
ADDRESS- LO zxlscsl-11�st
CITY: Ei STATE: -V
PHONE (DAYTIME)-.'VlQ- Ak�;l FAX: -Q
OWNER/BUILDER INFORMATION:
NAME: k-,ke clk ir \.c X=ZS
ADDRESS: y "o
CITY: STATE:
PHONE: FAX:
ARCHITECT/ENGINEERINFORMATION:
NAME:
ADDRESS:
CITY: STATE:'
PHONE (DAYTIME): FAX:
SLCCC: 9/23/09
Revised 04/26/2010
ZIP:
ZIP: