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OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
1.
2.
LOCATION/SITE
ADDRESS:
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Locip Count,
PERMIT #
RECEIPT #'� 2J
RECEIVED
PLANNING & DEVELOPMENT SERVICES -
BUILDING & CODE REGULATION DIVISION DEC 0 8 2015
2300 VIRGINIA AVENUE
FORT PIERCE, FL34982-5652 PERMITTING
(772) 462-1553 FAX (772) 462-1578 St. Lucie County, FL
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: rl S !
BUSINESS NAME: -pAlt
QUALIFIERS NAME: �. T
ADDRESS: V�
CITY:
PHONE (DAYTIME):1 i 61 _ 9 0 1 '
NAME:
ADDRESS:
CITY:
PHONE:
ST. LUCIE
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STATE:
FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME: £
ADDRESS: 4�; U V a
CITY: l ram- fa c. STATE: -T
PHONE (DAYTIME): -77 E29 - 1 Z-5 -7
Revised 07/22/2014
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CERT. #:'b-dOOZ�-3l9'
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OFFICE USE ONLY:
DATE FILED:
REVISIONFEE: ♦'��-j.�'
1.
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3.
4.
LOCATIO]
ADDRESS:
PERMIT # / JOO -ro y 0
RECEII'T# �µ�2J�
RECEIVED
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION . DEC 0 8 2015
2300 VIRGIIVIA AVENUE
FORT PIERCE, FL34982-5652 PERMITTING
(772) 462-1553 FAX (772) 462-1578 St. Lucie County, FL
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
,
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: SI 1 l
BUSINESS NAME: � a,1A Y saYL
QUALIFIERS NAME:
ADDRESS: U
CITY:
PHONE (DAYTIME): F2161_ 193-C .1. 1 'fig
OVMRBUH.DER INFORMATION:
NAME: trw Uj
ADDRESS: p 5.
CITY: C
PHONE: :7;27 5169_CI,Ps-Z
5. ARCHII'ECTBNGINEER INFORMATION:
NAME:
ADDRESS: O
CITY:
PHONE (DAYTEVIE):
Revised 07/22/2014
ST. LUCIE
STATE:
FAX:
1*j :iW.A
FAX: -772_ 569- it -w26 a�o
.o LQ 6 0-
LQVa
STATE: - ZIP: 3Z b
FAX: 772-_ E6G- u0 \Q
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