HomeMy WebLinkAboutREVISIONOFFICE USE ONLY: �r7a
DATE FILED: 0 N
REVISION FEE:
PERMIT #
RECEIPT #
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
LOCATION/SITE / 1
ADDRESS: S p I H Le i IUeS CI a , 1 . PkLCe
DETAILED DESCRIPTION OF PROJECT
REVISION&
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CONTRACTOR INFORMATION: 1%noo 9,,,,
STATE of FL REG./CERT. #: �� Nb§kLUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:
AT)T)RRSR-
CITY: STATE: 14n _ ZIP:
PHONE (DAYTIME):
OWNER/BUILDERINFORMATION: `U6A(, L
NAMEm/4•S ( j 1Ckce c
ADDRESS: Sao PAt&O Pt lJes C:.l R-.
CITY: STATE:
PHONE (DAYTIME: A63 -873l 4- FAX: _
ARCffiTECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130117
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