HomeMy WebLinkAboutREVISION 1OFFICE USE ONLY:
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DATE FILED: 2 - 19
PERMIT # / 70 L/ - C7 S / S
REVISION FEE: % J . RECEIPT # 600 6 I YS"I f e
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PLANNING & DEVELOPMENT SERVICES 6(;HNNEb
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DING & CODE REGULATION DIVISION ev
�2300 VIRGINIA AVENUE ' St.IIIripf'n��nh
FORT P(772)462 155382.5652
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APPLICATION FOR BUILDING PERMIT Rl;;;ILN I
PROJECT INFORMATION
LOCATION/SITE
ADDRESS: }�
roar P, >r l 3Y947
DETAILED DESCRIPTION OF PROJECT
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT
BUSINESS NAME: ddo
QUALIFIERS NAME: _ej
ADDRESS: ///N of
CITY: j
PHONE
. #: ST. LUCIE CO CERT. #:
1877- 707 - 1067 c.
OWNER/BUILDER INFORMATION:
NAME:
CITY: ; STATE:
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMATION:
FAX:
ZIP:
NAME: f7y �v'a,�ec.s.LL,y-
ADDRESS: h
CITY: Vz actcacl-f- STATE: ce I ZIP: 30x9e. 0
PHONE (DAYTIM ): 7-72. —,Ste9— 003 FAX:
SLCCC: 9123109
Revised 06130117 JAN 10 2018