HomeMy WebLinkAboutREVISIONOFFICE USE ONLY -
DATE FILED:
REVISION FEE:
SCANNED0 PERMIT #
S4 Lucle COUOCEIPT #
61 PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION D . *ISIO •
2300 VIRGINIA AVEN
FORT PIERCE, FL 3498 -
(772) 462-1553
APPLICATION FOR BUILDING PERMI
PROJECT INFORMATION f1tNi S
LOCATION/SITE
ADDRESS: ®� I pry - Ia S or
-2 `L
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: SAE: ZIP:
PHONE (DAYTIME): FAX:
OWNER/BUILDER INFORMATION:
NAME: Vtylcewtq-r�L6
ADDRESS:
CITY: 0 5 C STATE: ZIP:
PHONE (DAYTIME: qe . /1 FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: I
ADDRESS:
CITY: I STATE: ZIP:
PHONE (DAYTIME): I FAX:
SLCCC: 9/23/09
RECEIVE®
Revised 0WPI►V 7 "--=
MAY 14. 2019
Permitting Department
St. Lucie County, FL