HomeMy WebLinkAboutBuilding Permit DeferralOFFICE USE ONLY 22
DATE FILED:J'
REVISION FEE:' D'q-
PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION RECEIVED
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652 MAR 2-9 2022
(772) 462-1553
St. Lucie County
Permitting
APPLICATION FOR BUILDING PERMIT DEFERRAL
PROJECT INFORMATION
LOCATION/SITE
ADDRESS: d j �v�i� � I �,,`� -� C l -�
Z 2 � 1 � v��s�, � , 1
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CFRT- #: 6&e S-lJ% Z? ST. LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME
ADDRESS: Z
CITY: Coco L, ��C�-��� v ✓STATE: f ZIP: >�
PHONE (DAYTIME): '� j �/� ?`G�►� �`<.S" _ FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME:
STATE: ZIP:
FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 07117118
STATE: ZIP:
FAX: