HomeMy WebLinkAboutREVISIONOFFICE USE ONLY:
(L-) f S
DLATEILED:-
REVISION FEE:
1.
LOCATION/SITE
ADDRESS: aC/--
�1
SCANNLL,
BY
Lucie Coun..v.--.PERMIT # _.
RECEIPT i
PLANNING & DEVELOPMENT S Cl
BUILDING & CODE REGULATION D O
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-159
PPLICATION FOR BUILDING P
PROJECT INFORMATION --
i ( l (ZUCe!) eS5 CT
2. DETAILED DESCRIPTION OF ROJEC
REVISIONS:
'RECEIVED
OCT I 1 2om
eJ'CP � F
3. CONTRACTOR INFORMATIO :
STATE of FL REG./CERT. #: C5 C- 0 3 Z O 1 b ST. LUCIE COUNTY CERT. #:
BUSINESS NAME: 4-v c�
QUAL) ERS NAME: I (�(. q N yx l-,
ADDRESS:
CITY: VVVE�,t�ac� STATE:/ ZIP: 2Gt r7
PHONE (DAYTIME): `7 72_ 51V� - 4 q b FAX:
4. OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: I STATE:
PHONE: I FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: I STATE:
PHONE (DAYTIME): I . ' " FAX:
SLCCC: 9123109
Revised O 26/2010 "
ZIP:
ZIP: