HomeMy WebLinkAboutdeferreal formOFFICE USE ONLY:
DATE FILED:
REVISION FEE:
LOCATION/SITE
ADDRESS:
PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
APPLICATION FOR BUILDING PERMIT DEFERRAL
PROJECT INFORMATION
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: /A�`7W
BUSINESS NAME: I UJ'^ f-(' 1(
ST. LUCIE CO CERT. #:
QUALIFIERS NAME: ) - CC u" �u 4
ADDRESS: ' Of "'/'j
CITY: /jC rc ro S STATE: -�
PHONE (DAYTIME): / - - ' ri 6-( r) * FAX:
OWNER/BUILDER INFORMATION:
NAME: tZ-) I,
ADDRESS:'
CITY:
PHONE (DAYTIME:
Y
ZIP:
ARCHITECT/ENG, IN/EER INFORMATION: `
NAME: _ l t l h eca JLJ �GL
ADDRESS:
CITY: STATE:
PHONE (DAYTIME): 3-5- L /
SLCCC: 9/23/09
Revised 07/17/18
FAX:
ZIP: