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HomeMy WebLinkAboutRevision 6-3-14dLL OFFICE USE ONLY: DATE FILED: Ira 3 REVISION FEE: 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 1. SN/STTE ADDRE ' 1 lel k i `l 2. DETAILED DESCRIPTION OF PROJECT REVISIONS: b"Ir 3. CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: �'� ST. LU BUSINESS NAME: _ lb QUALIFIERS NAME: S ADDRESS: 391-( CITY: 5 T. 0 I-"p STATE: PHONE (DAYTIME): j FAX: 4. OWNERBUILDER INFORMATION: 4 NAME: ADDRESS: CITY: STATE: PHONE: ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: PHONE (DAYTIME): STATE: CERT. #: r_!3 ZIP: 7� ZIP: FAX: ZIP: FAX: SLCCC: 9/23/09 Revised 04/26/2010 n =� y' ¢° j `� y j`•• +�[1 0. r SkL Firv. Y,'� S4 al , bra a d.i �r' ,shy W «A �