HomeMy WebLinkAboutPermit Revision ApplicationOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
LOCATION/SITE
ADDRESS:
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PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES:`'""
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-565(
(772) 462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION � TO -
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DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C-4c j SG Q A Q D ST. LUCIE CO CERT. #:
BUSINESS NAME: I 5o4.-t 4,6kAV 6PIV ,jl�(�l orAl2 cr-
QUALIFIERS N E: ,24WAZ 41e u .
ADDRES : .A N A,
CITY: Lw STATE: a A ZIP:
PHONE (DAYTIME): 7? FAX: ,1y459
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMATION:
NAME: 24QL bjjjjA 90/L /-
ADDRESS: 1 91{ :5 W It C
CITY: E7e- : i+ LUC LE- STATE:
PHONE (DAYTIME):.
SLCCC: 9123109
Revised 06130/17 r
FAX:
ZIP:
ZIP: