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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
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
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STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME: �5 u "Ll rz
ADDRESS: Ian -3l�
CITY: ( STATE:
PHONE (DAYTIME): `3 TQ - t [1p FAX:
OWNER/BUILDER INFORMATION:
ZIP:
NAME:�F IC�t GC�•-
ADDRESS: .�: � M i A ,� .
CITY":
PHONE (DA'
,0- t Cif STATE: _ 1 � ZIP:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: ZO
PHONE (DAYTIME):
SLCCC.• 9/23/09
Revised 06/30/17
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