HomeMy WebLinkAboutREVISION - BUILDING PERMIT1�6
OFFICE USE ONLY:
DATE FILED: W
REVISION FEE: ta-7 5
LOCATION/SITE
ADDRESS:
1 °i
PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT
BUILDING & CODE REGULATION
2300 VIRGINIA AVEI
FORT PIERCE, FL 3498
(772) 462.1553
APPLICATION FOR BUILDING PE
PROJECT INFORMATION
41,� pL,&:& l h - s L f
'DETAILED DESCRIPTION OF PROJECT
REVISIONS: ,
CONTRACTOR INFORMATION:
STATE of FL REG./CERT.
BUSINESS NAME: YYl
QUALIFIERS NAME:
ADDRESS: 3 y S 0C1
CITY: Y93 L STATE:
PHONE (DAYTIME): 3 3 T- I 1 �,?
OWNER/BUILDER INFORMATION:
NAME: I
ADDRESS: 6? c tb�„1•,�„y Li
CITY: �'S� _ STATE:
PHONE (DAYTIME: 1
ARCHITECT/ENGINEER INFORMATION:
NAME: Ur Q t*rn
ADDRESS: 57YY6 A h 0
CITY: '� STATE:
PHONE (DAYTIME): 1w 3-- 7 y- - 1 2�
SLCCC: 9123109
Revised 06130/17
ST. LUCIE CO CERT. #:
FAX:
FAX:
FAX:
ZIP: S 1f
3 � - ag(d
ZIP:
ZIP: 3
SCANNED
BY