HomeMy WebLinkAboutRevisions OFFICE USE ONLY:
DATE FILED: ' /J PERMIT#
REVISION FEE: RECEIPT# 70
PLANNING & DEVELOPMENT . 11 Jim
BUILDING&CODE REGULATI0 I
2300 VIRGINIA AVENU
FORT PIERCE,FL 34982-5
(772)462-1553 FAX(772)46
APPLICATION FOR BUILDING I
PROJECT INFORM
1. LOCATION/SITE 9� /
ADDRESS: —16z q W B1,�'In n bys 1
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
add ede. '( c d Sb C nn-b a-cly r- moh n iew
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: Ua626 Wl�05 ST. LUCIE COUNTY CERT.#: D /
BUSINESS NAME: o LCC.
QUALIFIERS NAME: O'
ADDRESS: a*$ t')0 r
CITY: o,�� L STATE: ZIP: ✓_�3
PHONE(DAYTIME):7`1�'1- D& -O'a00 FAX: B8 33 - 6/To9
4. OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
Revised 07/22/2014