HomeMy WebLinkAboutREVISION 12-12-18RECEIVED SCANNED
BY
USE ONLY:
DEC 12 ?a t. Luds (county
TE FILED: la PERMIT #
Perrnitting 1)
Sr.Lp I ePartrn
VISION FEE: c e Cot-4rity ent RECEIPT #
PLANNING & DEVELOPMENT SE
BUILDING & CODE REGULATION D111
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5(
(772) 462.1553
APPLICATION FOR BUILDING PERM
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
0 e4W,5
DETAILED DESCRIPTION OF PROJECT
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. fi:
BUSINESS NAME:
QUALIFIERS NAME.
SI-A0 6w —nLla ADDRESS.
CITY: AMP STATE:
PHONE (DAYTIME): q25d-Zlt8-ffilP
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME:
MR,
s' " A g-6,2N
Q
ST. LUCIE CO CERT. #:
ZIP:
FAX:
STATE: ZIP:
FAX:
ARCHITECT/ENGINEER. INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130117
STATE:
I W., vim
ZIP: