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DATE FILED:
REVISION FEE:
PERMIT# /70tf^ 0,5-'/7
RECEIPT # 0006 I "(5-a I
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DMSION
1111 VIRGINIA AVENUE
C ANML py FORT PIERCE, FL 34882.5652
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APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
Sac)? 50vLg, lia-(C dcec CLr
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
BUSINESS NAME: a101-" ecv y-e r(
QUALIFIERS NAME: Ck4AM3 Cpsriy
ADDRESS: w Ol im 9">
CITY: ✓ ic) Oea-&I, STATE:
PHONE (DAYTIME): -7-2 7O7 9 6Z b
OWNER/BUILDER INFORMATION:
NAME: 7e. 94.ndS ONe
ADDRESS: —7 c-(.+k c2✓
CITY: ( c'erce- STATE: _
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMATION:
NAME: 02 I/ en ,„,e�ril'
-- — ADDRESS: / 35 oZ'o
CITY: VI -ID STATE: _
PHONE (DAYTIME): 17ZR. OD35
SLCCC: 9123109
Revised 06130117
SCANNED
BY
St. Lucie Countv
JAN 10 2018
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ST. LUCIE CO CERT. #:
_ ZIP: 3J ri (oa
FAX:
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ZIP: Id
FAX: