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HomeMy WebLinkAboutREVISION FORMOFFICE USE ONLY: DATE FILED: REVISION FEE: LOCATION/SITE ADDRESS: PERMIT # 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 DETAILED DESCRIPTION OF PROJECT REVISIONS: CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: C-6--L 15 ay'13� ST. LUCIE CO CERT. BUSINESS NAME: �'�Z-` (�:.�J�.�rs QUALIFIERS NAME: ADDRESS: S\` CITY: 'PSL STATE: PHONE (DAYTIME): - 11 Z, 33u _—(y, S3 FAX: OWNER/BUILDER INFORMATION: NAME: Ctnar-fie ��v ADDRESS: CITY: y' ; cg -c STATE: i� L - PHONE (DAYTIME: FAX: ARCHITECT/ENGINEER INFORMATION: NAME: Gar'" ADDRESS: Sl o E.�>. (S-e. e yr s VI-2 '4'o CITY: STATE: _ PHONE (DAYTIME): SLCCC: 9123109 Revised 06130117 ZIP: ZIP: 3`fq £f 1)- L- ZIP: FAX: