HomeMy WebLinkAboutREVISION - BUILDING PERMIT APPLICATION 2-1-19in
DATE
S. d 6
FEE:
LOCATION/SITE
ADDRESS:
PERMIT # /y 9 0 3 9
RECEIPT # I ��
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DMSION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462.1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
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DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C 6 C 4 C• �i C
BUSINESS NAME: & YqtP,. 1111
QUALIFIERS NAME: 420AUT G -4-
ADDRESS: a03 §, ;A d IZ-F ORI
CITY: f� c STATE:
PHONE (DAYTIME): 772, - 3 2-3 -71 ?7
d ST. LUCIE CO CERT. #:
FAX:
ZIP:
OWNER/BUILDER INFORMATION:
NAME: f a `9h' w m sr-�
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: ?,4y4 lvg�e'
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130117
4TATE: