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DATE FILED: I I Q PERMIT#�_[ 0-5 - Ol ofn
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REVISION FEE: RECEIPT#
PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE OCT 2 5 2019
FORT PIERCE,FL 34982-5652
(772)462-1553 ST. Lucie County, Permitting
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
DETAILED DESCRIPTION QF PROJECT
REVISIONS: l�) Si n91r
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: �tj, P/` (�,�f�nr ST.LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS: Qva-ya o-g rod }fid_
CITY: p(-�ear STATE: F— ZIP:
PHONE(DAYTIME: - _v FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: •
ADDRESS:
CITY: STATE: IP:
PHONE(DAYTIME): FAX:
SLCCC: 9/23/09
Revised 06/30/17
RECEIVED
MAY 0 6 2019
ST. Lucie 6gunty,Permitting
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