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HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT REVISIONOFFICE USE ONLY: DATE FILED: REVISION FEE: 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 LOCATION/SITE ADDRESS: ,Ez c's P_ Ivy DETAILED DESCRIPTION OF PROJECT REVISIONS: CONTRACTOR INFORMATION: t STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #: BUSINESS NAME: lqC1J P lQ, jai 11 LD i-L I QUALIFIERS NAME: 1rly `r T12I-'t 0 &C- U ADDRESS: 5 519S t' ef' )6 6/+/,! CITY: S fLLC1 STATE: F=L— ZIP: 9 C� PHONE (DAYTIME): "7%2. - & g cl - `7SQ 0 FAX: OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: STATE: PHONE (DAYTIME: ARCHITECT/ENGINEER INFORMATION: NAME: rr /l lr_lhe r C� 1p2 of e r s� ADDRESS: -' . 6 AFA5 7- ,Q�-i CITY: ` a a'V--4- STATE: PHONE (DAYTIME): T7a 6 `' a -17E�)00 SLCCC. 9123109 Revised 06130117 Q ZIP: ZIP:' FAX: % 702-- [� i - % 1 m