HomeMy WebLinkAboutPROJECT INFORMATIONl OFFICE USE ONLY:2 I
DATE FILED: I2A L t
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REVISION FEE: ISaD-b
PERMIT# SL L I
RECEIPT # d ap 13�a
PLANNING & DEVELOPMENT SERVICES fiU
BUILDING & CODE REGULATION DIVISION n0
2300 VIRGINIA AVENUE�On7 d�
FORT PIERCE,
(7 2) 462155382.5652 �j�Nb�s
I�'f� j[j' 'uno� a�nn7 ;CtJt� ' VLIf APPLICATION FOR BUILDING PERMIT REVI:DATE
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BUILDING DIVISION
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LOCATION/SE FOR COMPLIANC
ADDRESS: WED BY
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DETAILED DESCRIPTION OF PROJECT
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
BUSINESS NAME: Ticcm
QUALIFIERS NAME:
ADDRESS: 1 Gq1P
CITY: l X)Vb J
PHONE (DAYTIME): 15_W
WILL BE
ST. LUCIE CO CERT. #:
OWNERBUILDERINFORMATION: Z6;4cA 0(/ I1 L e
NAME: 84, I-JACj4. C131in I l�P2o�st/.�EI�L/ `Sa rot?
ADDRESS:Q'?)�)D jjfqnjQ CkNe,
CITY: --F:} (ace -p Q STATE: F _ ZIP: ,3499j--
PHONE (DAYTIME: '1`I..O -LILoa.- 140C) FAX: jrm
ARCHITECT/ENGINEER INFORMATION: ARE THE RESN8I9ILITY OF THE
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC. 9123109
Revised 06130117
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MOACTOROFRECORD
ZIP:
FAX:
THESE PLANS AND ALL PROPOSED WORK
ARE SUBJECT TO ANY CORRECTIONS
REQUIRED BY FIELD INSPECTORS THAT;
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