HomeMy WebLinkAboutDOC030922OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING &a CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5652
(772) 462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
r-of�
i-- t i c FL 424-6- -- Rat) n I noac I(
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
IeS J oR1 to 2 6-r 4r
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C'_13 0-1�1, 46 �,S' ST. LUCIE CO CERT. #:
BUSINESS NAME: &M P Qi11 LL)� S G -Lc
QUALIFIERS NAME: -/ rn o %7-R !PTn
ADDRESS: gf?9S % 6414 1 &
CITY:-S-ht_o , STATE: 1� ZIP: - r-
PHONE (DAYTIME): "7-7o2 _ (Q g of - ISO 0 FAX: `7 7Q-- lPoZ,
OWNER/BUILDER INFORMATION:
NAME:
ADDRF.SS:
CITY: STATE:
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:` t s L
PHONE (DAYTIME):
SLCCC.- 9123109
Revised 06130117
ZIP:
I