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APPROVED REVISION FORM, 518 EUROPEAN LN, FORT PIERCE, FL. 34982 SLC PERMIT REVISION APPLICATION
OFFICE USE ONLY: DATE FILED: REVISION FEE: LOCATION/SITE ADDRESS: 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 5 ar. L .rat# er�, FL. 3 yq%R DETAILED DESCRIPTION OF PROJECT REVISIONS: , I _ f4kwy-�51A L L C C� rPP-9 S CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: CrC#k /1/ 3�4 ST. LUCIE CO CERT. #: CFCzt-k JgYY433- BUSINESS NAME: I` QUALIFIERS NAME: ADDRESS: ice'-1S LTC. r� CITY: flctsi ' Ci STATE- ZIP: PHONE (DAYTIME): I , - `�I - q LACJ(4 FAX: %J*A OWNER/BUILDER INFORMATION: NAME: 3 nm�\C�c T4 ADDRESS: 50g CL,IYC4eay-t �-A. CITY: r STATE: F6, ZIP: 3L-19 S"Q PHONE (DAYTIME: - - [�96LI FAX: ARCHITECT/ENGINEER INFORMATION: NAME: 1� ADDRESS: _ CITY: PHONE (DAYTIME): SLCCC • 9123109 Revised 06130117 STATE: FAX: ZIP: