HomeMy WebLinkAboutAPPROVED REVISION Form 3.9.22PERMIT # ._ % Li `� LV
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
OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
NuIN
DETAILED DESCRIPTION OF PROJECT
REVISIONS: /_
ks-_Yis i c,ali►'�r245i r►'�l� `-
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C/3 (2, qj' ST. LUCIE CO CERT. #:
BUSINESS NAME: R & M P S l?-i 1 i L f uL C.
QUALIFIERS NAME: -/ a4 r n o `r Tpa pa" �a &'t_ 6
ADDRESS: 5 .5f9,S % Qd 61+1 l % �.✓11 � fJ .
CITY: sS ft c , STATE: P-4- ZIP: 47t 9Cv
PHONE (DAYTIME): `7-70J -fog a • `730 0 FAX:
6-4-6 'V-00
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME: FAX:
ARCERTECT/ENGINEER INFORMATION:
NAME: j eo d f-nde r soIj
ADDRESS: = S i 7- A A A
CITY: STATE: ��_
PHONE (DAYTIME): T t a 4di a - d7ESO FAX:
SLCCC.• 9123109
Revised 06130117
ZIP:
ZIP:
%3 -
0