HomeMy WebLinkAboutREVISIONOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
SCANNtc,
St. Luca C°unh,
PERMIT# / / d- 66rLI
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462.1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION Rccen
LOCATION/SITE
ADDRESS:
21cio -=Ain.QLtG ICA �-, L
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
Q,F 11ttL�Gl1 T
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: C3 ii X 4-1
BUSINESS NAME: C> oN
QUALIFIERS NAME: IT K>J
ADDRESS: -rr.-Fe P
CITY: —Fr4- r e,ee e STATE:
PHONE(DAYTIME): '77Z 6!8 36�'l
OWNER/BUILDER INFORMATION:
NAME:
APR .I I
53 0 ST. LUCIE CO CERT. #: 700 52
CITY: STATE:
PHONE (DAYTIME:
ARCIHTECT/ENGINEER (INFORMATION:
NAME: -A I QA-3 i-e-c+GN 1 c- -lo c-
ADDRESS: 90(o Ia.wa.ro- AVE
CITY: r- A- P` crcz
PHONE (DAYTIME): 77z - 'f60- 77t
SLCCC: 9123109
Revised 06130117
ZIP:
FAX: -n z -
ZIP:
ZIP:
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