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HomeMy WebLinkAboutAPPLICATION FOR PERMIT REVISION OFFICE USE ONLY: DATE FILED: PERMIT# REVISION FEE: 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 LOCATION/SITE ADDRESS: -1 DETAILED DESCRIPTION OF PROJECT REVISIONS: ��IS r®A/ F96YYI z.�(eA5--r ,nee CONTRACTOR INFORMATION: STATE of FL REG./CERT.#: / G 1,2- 146�,J'ST.LUCIE CO CERT.#: BUSINESS NAME: Q, JR L I i_L)� ' 1--LC QUALIFIERS NAME: m o`T TRf4—rn U ADDRESS: `T 5 .�9S% e?661 AJ CITY: STATE: = ZIP: 4 cy- 9�o PHONE(DAYTIME): ` 1-7' 2- (o g 61-7SO 0 FAX: - OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: STATE: ZIP: PHONE(DAYTIME: FAX: ARCHITECT/ENGINEER INFORMATION: NAME: I ADDRESS: 7- CITY: STATE: _ ZIP: PHONE(DAYTIME): FAX: -7'7c SLCCC: 9123109 Revised 06130117