HomeMy WebLinkAboutREVISIONOFFICE USE ONLY:
DATE FILED: . & ' 07•
REVISION FEE: 0
I. LOCATI01
ADDRESS:
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PERMIT # l 1bL1 -doZp� Lucie Counh,
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (77 578"' -',;
APPLICATION FOR BUILD&M
PROJECT INF
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
3.
4.
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: Q 80- 12 S i 5 U
BUSINESS NAME: -rc1s-�i u
QUALIFIERS NAME:
ADDRESS: In 15 S h pa_rr i
CITY: SChye. Gcp<a STA
PHONE (DAYTIME): I13-(ale- SaxOli
OWNER/BUILDER. INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE:
5. ARCHITECT/ENGINEERINFORMATION:
ADDRESS: _
CITY:
PHONE (DAYTDI4E):
Revised 07/22/2014
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ST. LUCIE COUNTY CERT. #:
FAX:
STATE:
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JUN 2 2 2017
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OFFICE USE ONLY:
DATE FILED: 6 ;)a -) %
REVISION FEE: .Igy
PERMIT# t Eby
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILD S
PROJECT E
1. LOCATION/SIIE
ADDRESS:
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2. DETAILED DESCRIPTION OF PROJECT
3.
4.
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS: I UR -I
CITY: SP1�Sen
PHONE (DAYTIME): Z
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OWNER/BUILDER INFORMATION:
NAME:
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CITY:
PHONE:
ARCHITECT/ENGINEER INFORMA
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
Revised 07/22/2014
FAX:
STATE:
STATE:
FAX:
FAX:
ZIP:
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JUN 2 2 2017
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