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DATE FILED: 1 -I PERMIT#
REVISION FEE: �lrj,• RECEIPT# I E Z I ��
PLANNING & DEVELOPMENT SERVICES RECEIVED'
BUILDING&CODE REGULATION DIVISION JUN 17 2019
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652 ST. Lucie County, Permitting
(772)462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
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DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: GG t 3 L av 7.37 ST. LUCIE CO CERT. 9:
BUSINESS NAME: C C,
QUALIFIERS NAME:
ADDRESS: 3Gf �V cu ����i7sb/r�y
CITY: %,�A 5I AvclGs STATE: L ZIP:
PHONE (DAYTIME): -7-7Z Z Zct 01 t t O FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): FAX:
SLCCC: 9/23/09
Revised 06/30/17 KtVISION
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