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DATE FILED: 07. c;2 PERMIT # / O " Z I
REVISION FEE: — -;\� • RECEIPT # -
Ea�C�IVED
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION J U L 2 2 2021
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5652 St. Lucie Coumc ,
(772) 462.1553 Permitting
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: rL - 6 S '-76 -K ST. LUCM CO CERT. #:
BUSINESS NAME: CAR 4. '1 A - CA R Pt) R6 TUC .
QUALIFIERS NAME:
ADDRESS: 1,97 L'_,4pawl s0GTim- .1, _
CITY: STATE: _ N G ZIP: X7 D / 1
PHONE (DAYTIME): 3l0 76gQ0 FAX: —�
OWNER/BUILDER INFORMATION:
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FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: d
P:
PHONE (DAYTIME): 7•
SLCCC: 9123109
Revised 0 613 0/17