HomeMy WebLinkAboutRevisions; Stem WallOFFICE USE ONLY: j� 22
DATE FILED: (0 O� 1 I a' PERMIT # ' II D' - 0 J J,
REVISION FEE: RECEIPT#
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION R�EIVEk3
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652 JUN 2 9 1011
(772) 462.1553
Pe"'!uce County" Department
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APPLICATION FOR BUILDING PERMIT DEFERRAL St . L
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
J I 1 z
DETAILED DESCRIPTION OF PROJECT I
REVISIONS: Bern �- OaA Y7C
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:, 1�
CITY: JL STATE:
PHONE (DAYTIME): 6711ww9rw
ST. LUCIE CO CERT. #: Z12ao
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ZIP:
OWNERMUILDER INFORMATION: COPY
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NAME: FILE COPY
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: �PQ,u' _Ul->0rh
CITY: tD L
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130/17