HomeMy WebLinkAboutAPPLICATION FOR BUILDING PERMIT REVISIONSOFFICE USE ONLY:
DATE FILED: 3�'40 1 \-�
REVISION FEE: le, , 13
PERMIT# /v(�Z� 45:77
RECEIPT # 'I 3s 6 66
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5652
(772) 462.1553
APPLICATION FOR BUILDING PERMIT REVISIONS a/�7
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:3P/7L E
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: CGl ST. LUCIE CO CERT. #:
BUSINESS NAME: LL G
QUALIFIERS NAME: L /rf v w0 Z
ADDRESS: L-w
CITY: A rs STATE: L
PHO (DAYTIME): 77 Z L Z q cAI 1 J FAX:
OWNER/BUILDER INFORMATION:
ZIP: 2 q q 0 3
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME:
ARCHITECT/ENGINEER-INFORMATION:
NAME: _
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130117
STATE:
•
FAX:
Ill
ZIP: