HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT REVISIONS»`
OFFICE iUSE ONLY:
DATE FfED:
REVISION FEE:
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PERMIT # S 4G i g0 8 - Oy ( 3
RECEIPT #
- PLANNING &.:DEVELOPMENT SERVICES.'ANNE®.
BUILDING &. CODE REGULATION DIVISION By
2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 . �t���yy
. two r"o,* mv ..
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE.
ADDRESS: 3 �10 �1 1 N
r'aR-i �lI=UGCi-
DETAILED DESCRIPTION OF PROJECT
REVISIIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: RX" O W N " ST. LUCIE COUNTY CERT. #: y��3
BUSINESS NAME: p1oNEm SC12e'CA ro. -'NC. �3r .
QUALIFIERS NAME: M.I e N �Y 6 L. N E W M A IJ
ADDRESS: SW 131 LTM O 2 C, s-r.
CITY: po,tr S?. (u&W . - STATE: ' ZIP:, , r. 34 4
PHONE (DAYTIME): 1112) 340 -L13Q3 FAX. r 2)�3y0-,%zc
OWNEWBUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
.PHONE: FAX:
5. ARCHITECT/ENGINEER INFORMATION:
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NAME: 'Do 16AA + Assoc.
ADDRESS: 0 10039
CITY: A{ M P A STATE: ZIP: 33 6'i
PHONE (DAYTIME): Tj 3) 915- q 4 55 FAX:,
Revised 07/22/2014
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