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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
44- 21OZ-05-1
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
CSC 15n5'vo? �
STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #: ZOS 5-1/
BUSINESS NAME: A' � 47n i in L
QUALIFIERS NAME. (, , o j
ADDRESS: A-vc
CITY:. V.,,t o QiLr , (.i STATE: f2 L ZIP: I Z9 e 7
PHONE (DAYTIME): 7 7 2 _ sg _ 06 � S FAX:
OWNERJBUILDER INFORMATION:
NAME: —Z -;'--u �/20 /�
ADDRESS: /Sa ; u,ran M
CITY: pg l v,,, 15,e & LG, STATE: let
PHONE(DAYTIME: 1161- g 9 FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME: _ b'
ADDRESS:
CITY: V4ff a
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130/17
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ZIP:
l- ZIP: -
FAX: