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DATE FILED: -x �3d� \ -�
REVISION FEE: 6 GA _ O
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PERMIT # O 2- c/5 ✓ U 2 S) v
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE SC
FORT PIERCE, FL 34982.5652
(772) 462.1553
APPLICATION FOR BUILDING PERMIT REVISIONS �04
PROJECT INFORMATION �y
LOCATION/SITE
ADDRESS:
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DETAILED DESCRIPTION OF PROJECT
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: L-(-I(L
BUSINESS NAME: 2 i � i2e S 0.K .T
QUALIFIERS NAME: Sc-o �-
ADDRESS: 'LI3o i-- (L
CITY: _l )C 'Jis STATE: _
PHONE (DAYTIME): 9 .S (� s2 3 - %n LI
OWNER/BUILDER INFORMATION:
NAME:
CITY: J)_eI
PHONE(DA
�d ST. LUCIE CO CERT. #:
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^� ( ZIP:
FAX:
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ARCHITECT/ENGINEER INFORMATION:
NAME: MC rj �� a A4 SSOC 10. S
ADDRESS: `��S C 'fSc�q 10
CITY: ('A rrA ✓ t.Jw r STATE: L
PHONE (DAYTIME): `�] 7 9D D 2 FAX:
ZIP:
Revised 06130117
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