HomeMy WebLinkAboutREVISION 1-3-19 PERMIT REVISIONOFFI T E USE ONLY:
DATE ILED: , y PERMIT #Is
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REVIS ON FEE: ° CS CAS RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 RECEIVED
APPLICATION FOR BUILDING PERMIT REVISIONS JAN 0 3 2-219.
PROJECT INFORMATION `
ST. LUCIe County, Permitting
11l LOCATION/SITE
ADDRESS;
DETAILED DESCRIPTION OF PROJECT
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: Cf)e YS'SSaq ST. LUCIE CO CERT. #:
BUSINESS NAME: o
QUALIFIERS NAME: u �,, �b I - 0 4!'N �
ADDRESS: �5 Ll I q /lL . '
CITY: STATE: c ZIP:
PHONE (DAYTIME): —T-7Q 5O S 0 1 V 1 FAX: A14-
OWNER/BUILDER INFORMATION:
STATE:
TE (DAYTIlVIE:
HTECT/ENGINEER INFORMATION:
ZIP:
"ME: 6104 rN AR t � �
�kDDRESSS:
10,E 9g , SLlno rn 61 if,4 i Ia I �-•
?HONE STATE: ZIP:
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(DAYTIME): 3 OS T 19 D S' <!/ FAX:
LCCC: 9/23/09
evised 06130/17
r'rtEVISIONE F!14
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