Loading...
HomeMy WebLinkAboutRevision 11-7-18OFFICE USE ONLY: DATE FILED: It 1-7 113 REVISION FEE: 4 % 5 PERMIT # (2177) RECEIPT # PLANNING & DEVELOPMENT SE aC RECE ® BUILDING & CODE REGULATION D `" ; }. " , 2300 VIRGINIA AVENUE ; 3 , �•� F AWA NOV 0 i FORT PIERCE, FL 34982-5 �,: p� 8 (772) 462-1553 y }r f15" , 101 ,fir . � � � �;� FFrilkiln`' �G �` UP sth, Wele Pan megtCou h'APPLICATION FOR BUILDING PER E ($fQS, g PROJECT INFORMATION:" LOCATION/SITE ADDRESS: 4 12-144 DETAILED DESCRIPTION OF PROJECT REVISIONS:; 19,42 'F_' /-,,*> d a 2 e hi,44, , tN A Al A 0 0 2 C -P 4,we g• 1 CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #: BUSINESS NAME: QUALIFIERS NAME: N f5l 0 zrate M4�-� ADDRESS: (/06 D CITY: Fl-, n/ 9/Z C/.£ STATE: /ckd P i .04 PHONE (DAYTIME): 6/ S/ 3 S Y/ 6 14/ FAX: OWNER/BUILDER INFORMATION: NAME: k-/,D )e�41" ADDRESS: &/ b 0 11 0/i►//1 7—�/___ 11; 0 10 K CITY: a P/R/e @ % STATE: PHONE (DAYTIME: 6 / y-3,-'z1 - /6 /y I FAX: _ ARCHITECT/ENGINEER INFORMATION: ZIP: 7 Y 9 Ir 7- ZIP: NAME: A A 0 A l T',E e T ©/v / C ADDRESS: 8 OC ba 1,4 w'q Rx 4 1119!5 CITY: Fr, P1/=/2 0_1Z STATE: � 4 ZIP: 3 V 21`0 PHONE (DAYTIME): ` ,72 - 516 6 •- 77 S'0 FAX: 77 2 - S/6 D - Y 2- Y;; SLCCC. 9123109 Revised 06130117