HomeMy WebLinkAboutREVISON BUILDING PERMITi
i
OFFICE USE +ONLY:
DATE FILED:I
REVISION FEE:
PERMIT #
RECEIPT #
PLANNING & DEVELOPMEP
BUILDING & CODE REGULATI
2300 VIRGINIA A
FORT PIERCE, FL 3
(772) 462-15
APPLICATION FOR BUILDING
PROJECT INFORMATI!
LOCATION/SITE
ADDRESS:
1�S`70 5.
AILED DESCRIPTION OF PROJECT
INFORMATION:
STATE of FL REG./CERT. #:
BUSINESS NAME: r /,-V:
QUALIFIERS NAME:
ADDRESS:
CITY: V F L
PHONE (DAYTIME):
C P6 11)5-712 o
ST. LUCIE CO CERT. #:
&r A STATE: F/..
'7'72 q-22 ---23 c� q FAX:
INFORMATION:
NAME: DO L-,-t x4 I -Ali+
STATE:
(DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: C U %. T-i S - -5 / Aw 0- i A- Z bV1 -
ZIP: 32
ZIP:
ADDRESS: _ `92-`1' kl., /{'I LI IIVZ f '2I -
CITY: PAL 111 25CJ/ 6AAQ j�.5 STATE: / � ZIP: 3 3 y / 9
PHONE (DAYTIME): sw 6':36 FAX:
SLCCC 9123109
Revised 06130/17
i
r