HomeMy WebLinkAboutREVISION 1OFFICE USE ONLY:
v • DATE FILED: � � i�./ '� D ISCANNEDBY PERMIT # _
REVISION FEE: /.� • St. Ll1CIP. COUfitV RECEIPT #
I
PLANNING & DEVELOPMENT. SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5652
(772)462.1553
APPLICATION FOR BUILDING PERMIT R S �r�l®
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
S;L lso 61.!}/Ge raei � G i A. 13 CL 12.
Fblr �o«L Jy?j/.
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
B/ol . i ;IL
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME: C lW cLr ¢s a o,S.L tV
ADDRESS:
CITY: UCAa t3n4atf STATE: - ZIP: 32961S
PHONE (DAYTIME): 19 77. 70 9- gr(e 7 C. FAX:
OWNER/BUILDER INFORMATION:
NAME: 7Le- 5.#AA/-r Oluc_ &o,vc%nj;u,',.@s
CITY: ICotr P4,e•C- STATE: A— ZIP:
PHONE (DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
CITY: ✓ctx (be,4CI. STATE: .I ZIP:
PHONE (DAYTIME): 7� OD 3S FAX:
9123109
Revised 06130117
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