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APPLICATION FOR REVISION
OFFICE USE ONLY: DATE FILED: _ REVISION FEE: 1. 2. LOCATION/STFE ADDRESS: 10701 S OCEAN PERMIT # RECEIPT # PLANNING & DEVELOPMENT SERVICES SCANNED BUILDING & CODE REGULATION DIVISION BY 2300 VIRGINIA AVENUE FORT PIERCE, FL34982.5652 St. Lucie County (772) 462-1553 FAX (772) 462-1578 APPLICATION FOR BUILDING PERMIT REVISIONS PROJECT INFORMATION JENSEN BEACH FLORIDA DETAILED DESCRIPTION OF PROJECT REVISIONS: 3. CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: CGCO05589 SSBT�IIJC>IE�OUNTY CERT. #: BUSINESS NAME: LLDL QUALIFIERS NAME: ADDRESS: P.O. BOX 28 CITY: JENSEN BEACH STATE: FLOIZIDA ZIP: 3499 PHONE (DAYTIME): FAX: 7722203277 4. OWNERBUILDER INFORMATION: NAME: ADDRESS: CITY: STATE: ZIP: PHONE: FAX: 5. ARCHITECT/ENGINEER INFORMATION: NAME: GRANFIELD ARCHITECHS ADDRESS: 1683 NE JENSEN BEACH BLVD CITY: TENSED STATE: FT, ZIP: 34957 PHONE(DAYTIME): 7777R3601') FAX: 722WI50 Revised 07222014