HomeMy WebLinkAboutRevisions OFFICE USE ONLY: t /
PERMIT#
DATE FILED: 1 �I �a
REVISION FEE: RECEIPT#
N � PLANNING & DEVELOPMENT SERVICES
BUILDING&CODE REGULATION DMSION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 FAX(772)462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
1. LOCATION/SITE
ADDRESS: °7-01 jJE V ISTA
ST. L-O(-1 E1. Vii. lL{�'J3
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
i Z t�d V t_`p 6 AT t-p-Owl k:.N -r S t t�g dr tP�PQ-Nt `f ..
� . wtoy.cb '9 %L-r4-r StaC c;,bqr-N: L®c-c row ro I=R-0IjT-
'3 1O &r ATC ?pAl..L
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: ST. LUCIE COUNTY CERT.#:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
4. OWNER/BUILDER INFORMATION:
NAME: b A RtRtRkA.1 y4t_L-gC-
ADDRESS: 7-0 pfil t.M,IA vis-%-K zwj t1
CITY: Qd XT 'ST. L V L t e STATE: �.. ZIP:
PHONE: -7177- - q l7q - SZofd7 FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX:
Revised 07/22/2014
it i I � I I� i ! � i � '• ��i I I � � ,
I
N
�VI
2-0 i , �l e, ���vvl