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HomeMy WebLinkAboutpermit 2104-0592 revisionOFFICE USE ONLY: DATE FILED: ` T PERMIT # S A w- cnA rQ REVISION FEE: 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: _, DETAILED DESCRIPTION OF PROJECT REVISIONS: l �`�`� ,\ -F`�` a-4 — V % _ — Yl — . " dl �Y r A !"X1 rl n CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #: BUSINESS NAME: ], (_. �� � t C!2, QUALIFIERS NAME: ADDRESS: t�jw Pat Cd 6 o ct CITY: Pc�ky STATE: ZIP: , PHONE (DAYTIME): `1') 2 (o,(n �W FAX: _ ^ OWNER/BUILDER INFORMATION: NAME: —��Ood Ga��- 0(c�- ADDRESS: _c Qon di'n t)C� X -P CITY: U L"Y�ll, STATE: ZIP: PHONE (DAYTIME: ��� -� ��,� ^_ FAX: \ v ARCHITECT/ENGINEER INFORMATION: NAME: _ ADDRESS: CITY: PHONE (DAYTIME): SLCCC: 9123109 Revised 06130117 STATE: ZIP: FAX: