HomeMy WebLinkAboutRevisions OFFICE USE ONLY:
DATE FILED: 6 PERMIT It
REVISION FEE: . l RECEIPT# U��
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
1. LOCATION/SITE kk
ADDRESS: 3 ;-O'3 �f12 V�t�w
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
L )-k
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#:( 5-147 Ll ST.LUC E COUNTY CERT.#:
BUSINESS NAME: v i.
QUALIFIERS NAME:
ADDRESS: Po 0 5�
CITY: V 2+-0 STATE: r I ZIP: ��G
PHONE(DAYTIME): '11'a- 3 T'U f O 1 FAX:
4. OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX:
5. ARCHITECT/ENGINEER.INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
SLCCC:9/23/09
Revised 04/26/2010