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HomeMy WebLinkAbout2014_Revision_Form (1)OFFICE USE ONLY: DATE FILED: _____________________ PERMIT # ________________________ REVISION FEE: ___________________ RECEIPT # _______________________ ______________________________________________________________________________________________ PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772) 462-1553 FAX (772) 462-1578 APPLICATION FOR BUILDING PERMIT REVISIONS PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: _______________________________________________________________________________________________ _______________________________________________________________________________________________ 2. DETAILED DESCRIPTION OF PROJECT REVISIONS: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________ 3. CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: ____________________ ST. LUCIE COUNTY CERT. #: __________________ BUSINESS NAME: _________________________________________________________________ QUALIFIERS NAME: _________________________________________________________________ ADDRESS: _______________________________________________________________________________ CITY: ________________________ STATE: _______________ ZIP: _______ PHONE (DAYTIME): ________________________ FAX: ______________________________________ 4. OWNER/BUILDER INFORMATION: NAME: _________________________________________________________________________________ ADDRESS: _________________________________________________________________________________ CITY: _____________________________ STATE: ___________________ ZIP: ____________ PHONE: ___________________________ FAX: __________________________________ 5. ARCHITECT/ENGINEER INFORMATION: NAME: _________________________________________________________________________________ ADDRESS: _________________________________________________________________________________ CITY: _____________________________ STATE: ___________________ ZIP: _______________ PHONE (DAYTIME): ________________________ FAX: ____________________________ Revised 07/22/2014