HomeMy WebLinkAboutREVISIONS 1OFFICE USE ONLY: /
DATE FILED: 1 14 6l0
REVISION FEE:
1. LOCATION
ADDRESS:
2.
3.
4.
PERMIT# 1-6m-0099
RECEIPT #
PLANNING & DEVELOPMENT SERVICES SCANNED
BUILDING & CODE REGULATION DIVISION BY
2300 VIRGINIA AVENUE St. Lucie C01'^
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C 9 C 151959a ST. LUCIE COUNTY CERT. #:
BUSINESS NAME: pQP I II b Qm<1 1 [ <
QUALIFIERS NAME:
ADDRESS: v u
CITY: ile p=Q P141% .U- STATE: . 01. , ZIP: 132 (moo
PHONE (DAYTIME): -7 7z 311 - 9 ii a FAX:
OWNER/BUILDER INFORMATION:
NAME: T I m
ADDRESS: 69
CITY: -v+� e wj(.e- STATE:
PHONE: --11-) 4
5. ARCHITECT/ENGINEER INFORMATION:
NAME: T
ADDRESS:
CITY:
PHONE (DAYTIME):
FAX:
FAX:
Revised 071=014
Y •S„ �.0 4 RY •• ti
ZIP:
K�
�4
rs
OFFICE USE ONLY:
DATE FILED: {-(p
REVISION FEE:
1.
2.
3.
4.
LOCATION/SITE
ADDRESS:
PERMIT #
RECEIPT #
S�
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERAUT REVISIONS
PROJECT INFORMATION
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C 9 e 15/95ga ST. LUCIE COUNTY CERT. #:
BUSINESS NAME: ►a P 1,11 e Loln4l • /-< <
QUALIFIERS NAME:
ADDRESS: 3z l T
CITY: kjer o STATE: 0rk ZIP: 326,1-
PHONE (DAYTIME): -7 72 3 2 ! - 3 ri a FAX:
OWNER/BUILDER INFORMATION:
NAME:
T
ADDRESS:
CITY:
r�
PHONE:_
5. ARCHITECT/ENGIN
NAME:
T
ADDRESS:
�L
CITY:
V
PHONE (DAYTIME):
INFORMATION:
ZIP:
FAX:
STATE: fit o ✓\ a ZIP:
FAX: