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HomeMy WebLinkAboutRevision form, relocate footer OFFICE USE ONLY: h3 DATE FILED: 1701-o3ld PERMIT� REVISION FEE: �' RECEIPT It PLANNING &DEVELOPMENT SERVICES BUILDING&CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE,FL 34982-5652 tego. pQt StLi� it (772)462-1553 APProved APPLICATION FOR BUILDING PERMIT REVISIONS I _� PROJECT INFORMATION rO-4 ' I V LOCATION/SITE `' e(4 ` ADDRESS. CP6 9 Qd L PERM '3py, 6448 e-lij A 3q9y0 DETAILED DESCRIPTION OF PROJECT REVISIONS: ' RELOC�E -a -7&x- CONTRACTOR INFORMATION: STATE of FL REGJCERT.#: CPS y5-kG 9(a ST. LUCIE CO CERT. BUSINESS NAME: _ pgy A4VF4S , POOL S QUALIFIERS NAME: a 1/,�Al R G iU&I ADDRESS: 724- ge- ROd ref&V 9044 CITY: 5TuAtr STATE: zip: 3y49 y PHONE (DAYTIME): ?7 2-5(/9- 5/S/ FAX: ?72-ql9-5Y0/ OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: STATE: ZIP: PHONE(DAYTEME: FAX: ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): FAX: SLCCC:9123109 KEVISION Revised 06/30/17