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DATE FILED: PERMIT #
REVISION FEE: RECEIPT #
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LOCATION/SITE
ADDRESS:
33
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772).462-1553
APPLICATION FOR BUILDING PERMIT DEFERRAL
PROJECT- INFORMATION
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
RM S e d �,Ul
CONTRACTOR INFORMATION:
STATE of FL REG./C C I o6
BUSINESS NAME: I U
QUALIFIERS NAME: OtlYI
ADDRESS: �a t�
CITY: Or GA\'D STATE;
PHONE (DAYTIME): QO� - Aa -9
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMATION:
NAME: ll ; d
ADDRESS: I
CITY:
PHONE (DAYI
SLCCC: 9123109
Revised 07117118
C
RECEIVED
MAR 17 2022
St. Lucie County
Permitting
ST. LUCIE CO CERT. #:
FKMA
FAX:
ZIP:
ZIP: