HomeMy WebLinkAboutREVISION 10-1-18 OFFICE USE ONLY: SCAN j, ED
DATE FILED:�� ( Yo/ �U��� ��� V PERMIT#
REVISION FEE: `�� RECEIPT#�� a
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PLANNING&DEVELOPMENT SERVICES
BUILDING&CODE REGULATION DIVISION RECEIVED
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 O C T 012018
APPLICATION FOR BUILDING PERMIT REVISION 5T. Lucie County, Permftng
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
DETAILED DESCRIPTION OF PROJECT '
REVISIONS: % -
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: CG GOI (U ST. LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME: Doti /�i,l7�L�
ADDRESS: a/ ` w�
CITY: i o STATE: f / ZIP: Z ? �,a
PHONE(DAYTIME): FAX: 2 7 Z-•- ,7- /a �2
OVVNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS: �
CITY: a-,- 5r A STATE: er-=( ZIP: 3 ��Y
PHONE(DAYTIME): 77 Z 79 9 P OI FAX:
SLCCC: 9123109
Revised 06/30/17 REVISION ,