HomeMy WebLinkAboutREVISION PERMIT APPLICATION - CHANGING MATERIALOFFICE USE ONLY:
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DATE FILED: iK,u I 0 q
PERMIT # RECEIVED
REVISION FEE: `1S•100 RECEIPT# DEC 041000
Permltting Department
St. ut e.OLY
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FILE COPY FORT PIERCE, FL 34982.5652
(772)462.1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE SCANNED
ADDRESS: BY
5Z0 A/t+A-WV 131VJ StIiiriarnllnt_;
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
BUSINESS NAME: COZt, p,,� mvo FAG
QUALIFIERS NAME: ao v 4 1 a r E.
ADDRESS: 371t tt T I c-+tr
CITY: ��rw r- STATE:
PHONE (DAYTIME): �� L- ?-F 2 - ZL- 2,F 2 - Z -
OWNER/BUILDER INFORMATION:
CITY:
PHONE(DA'
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c c h STATE:
ARCHITECT/ENGINEER INFORMATION:
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ST. LUCIE CO CERT. #:
_ ZIP:
FAX: ?"?-L -
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ZIP:
CITY: STATE: ZIP: _
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130117
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