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DATE FILED: PERMIT# 'OOP
REVISION FEE: L o cb • gs RECEIPT#
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
LOCATION/SITE
ADDRESS: '
-70 3 (J/r l d i <2,,l re rl L rc
DETAILED DESCRIPTION OF PROJECT
REVISIONS: �
CONTRACTOR INFORMATION:
STATE of FL REG./CERT G6� �"a�!3/ ST. LUC CO F,RT. #:
BUSINESS NAME: C • �-
QUALIFIERS NAME:
ADDRESS, / S "It
CITY: 60--k Alzvx.4' STATE: /�(, ZIP:
PHONE A TIM ): :7 7 2, 33. S'?S 3 FAX:
OWNER/BUILDER INFORMATION:
NAME: j kOlJ
ADDRES
CITY: 1 ►A{� STATE: e c ZIP:
PHONE( AYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME):
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SLCCC: 9/23/09
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