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HomeMy WebLinkAboutAPPROVED REVISION, FormOFFICE USE ONLY: DATE FILED: 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 LOCATION/SITE ADDRESS: PILP—cc— FL DETAILED DESCRIPTION OF PROJECT REVISIONS: kI-rlV 16 i 0 Aj I F96M 1ple�e-A6-r Ln4-�--15 -60 POWE-P, 45r'EE'L� CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: C/3 ST. LUCIE CO CERT. #: BUSINESS NAME: R-CE—MI-112, jaj]ILL)piLC QUALIFIERS NAME: 1-no'r 2a ADDRESS: 7' 4Q e, 6A-Al CITY: 5 STATE: f7t- ZIP: PHONE (DAYTIME): -7%2 - & c? a - _780 0 FAX: EJ-14-6 OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: STATE: PHONE (DAYTIME: FAX: ARCHITECT/ENGINEER INFORMATION: NAME: o- 6 e- / � & jde-r-50"i ADDRESS' 1:3717 7- 6e9a-A Al 6Lv-, CITY: N-�VI-4 STATE: /::F- PHONE (DAYTIME): Tj ( o9 ol - qE�00 - -- FAX: SLCCC 9123109 Revised 06130117 WMI ZIP: ZIP:, -3/ '%� 4L