HomeMy WebLinkAboutAPPLICATION FOR PERMIT REVISIONOFFICE USE ONLY:
DATE FILED: Z— a
REVISION FEE:
PERMTF'# 1:3(z, 03yo
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
9UILDING & CODE REGULATION DIVISION RECEIVED
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 JAN 2 2 2018
APPLICATION FOR BUILDING PERMIT REVISIO T. Lucie County, Permitting-
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
51 OA-V-, e—
AT— T�-t 3`c
DETAILED DESCRIPTION OF PROJECT
REVISIONS: o
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CONTRACTOR INFO'10, ?AT -ION:
STATE of FL REG./CERT.
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS: 17 %Jw G
CITY: STATE:
PHONE (DAYTIME):��
OWNERBUILDER INFOleldATION:
NAME:
ADDRESS: i ✓Cs
CITY: L%U 1 f: _t
PHONE (DAYTIMF:
0t,01A L r/' --&W
ST. LUCIE CO CERT. #:
zip: c� y
FAX: /16?- -�f -( -/
STATE: �2 _ ZIP:
- FAX:
ARCHITECT/ENGINEER TVFORNIATION:
NAME: -I -=' No
ADDRESS: Illr2-40
CITY: W+nrt-LrSTATE:
PHONE (DAYTIME):
SLCCC: 9123109 -
Revised 06130/17 -
FAX:
ZIP: