HomeMy WebLinkAboutREVISION 7-16-19FFICE USE ONLY: / Q
F• D I TE FILED: • �� (� PERMIT # d Q C1
R VISION FEE: et7 RECEIPT #
PANNING & DEVELOPMENT SERVICES SCANNED
BUILDING & CODE REGULATION DIVISION By
2300 VIRGINIA AVENUE r
rt'�"ryy) / 4 FORT PIERCE, FL 34982-5652 S' Lucie Cou�y
(772) 462-1553
APPLICATION FOR BUILDING PERfljjV I S
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PROJECT INFORMATION
LOCATION/SITE
ADDRESS: Al
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: 67 (7 G 0
BUSINESS NAME:
6//
QUALIFIERS NAME:
1 d6s&
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ADDRESS: / 76S—
M9L RE '
Z
CITY:
STATE:
PHONE (DAYTIME):
9ey/ 71/c,V
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OWNER/BUILDER INFORMATION:
NAME: ,✓L •
�1/
ADDRESS:
CITY: )5::' , e►tic�'
STATE
PHONE (DAYTIME: !RC�/
--
EER
ARCHITECT/E;10
INFORMATION:
NAME:
ti
ADDRESS: iaizrj
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,4L L%
ST. LUCIE CO CERT. #:
ZIP: s� &
FAX:
FAX:
CITY: 1/ 6&16 SATE: _j-Z ZIP: 3z
PHONE (DAYTIME): �-72. ` �I�% G 7 S� FAX:
SLCCC: 9123109 RECEIVED
Revised 06130117 J U L 16 2019
Permitting Department
St. Lucie County, FL