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REVISION FEE: RECEIPT#
ir- PLANNING&DEVELOPMENT SERVICES -
BUILDING&CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772),462-1553
APPLICATION FOR BUILDING PERwr REVISIONS
PROJECT INFORMATION
1. LOCATION/SITE
ADDRESS: I W(-)-IFFZK 866 G U'S Y,
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2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: QC2 C f S b 8 2 5 1 ST.LUCIE COUNTY UERT.#:
BUSINESS NAME: l OAS' af Con kcW
QUALIFIERS NAME: rPG af21 4
ADDRESS: Ad cl Sc•) Atc cA ek% .z
CITY: Por+SNPT Lucre F(. STATE: ZIP:
PHONE(DAYTIME):17-4 -8'21—g?-W FAX:
4. ONMRBUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: a k15
PHONE(DAYTBIE): TA 9
SLCCQ 9123109
Revised 04/26/2010
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RE-VIbION
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