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LOCATION/SITE
PERMIT #
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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
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DETAILED DESCRIPTION OF PROJECT
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: ACC C 5� ST. LUCIE CO CERT. #:
BUSINESS NAME: L
QUALIFIERS NAME: a t e l 2
ADDRESS: [31v -�-tDo\
CITY: ,, STATE: f L ZIP: 3� 11°1
PHONE (DA TIME): 41-1 y IQ _ (� 0U FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: Ak STATE: 4- L
PHONE (DAYTIME: Co - C(I- Ll Ct4 FAX: _
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130117
STATE:
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ZIP: 3 ;? IGo d
ZIP: