HomeMy WebLinkAboutRevision-Added plywoodOFFICE USE ONLY:
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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
VISI NS:
I� $
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: CC_C i ':� W) a ST. LUCIE CO CERT. #:
BUSINESS NAME: 4. � (�nr �e ne re i C
QUALIFIERS NAME: 4.juS c �l ►'CGS
ADDRESS: (sL"7S S ysi nv'�-A
CITY: PVC-)r 6erc>_ STATE:
PHONE (DAYTIME): j--t _ W CQ I I.3 S FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME:
STATE:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC.• 9123109
Revised 06130117
STATE:
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ZIP: 3(4 -144 S
ZIP:
ZIP: