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HomeMy WebLinkAboutAPPLICATION FOR PERMIT DEFERRALOFFICE USE ONLY: .q X0 7,Z) BY DATE FILED: I frip rounw REVISION FEE: ob PERMIT# RECEIPT # rlDCJ67 PLANNING, & DEVELOPMENT SERVICES BUILDING .& CODE REGULATION DIVISION 2300 VIRGINIA AVENUE I FORT PIERCE, FL 34982-5652 1 (772) 462-1553 ' . TION FOR BUILDING PERMIT DEFERRAL PROJECT INFORMATION LOCATION/SITE S kc(k DETAILED DESCRIPTION OF I REVISIONS: �_n_ CONTRACTOR INFORMATION: STATE ofFL REG./CERT. BUSINESS NAME: QUA)LIFIERS NAME: ADDRESS: CITY:. S.TATE: PHONE (DAYTIME): OWNERIBUILDERINFORMATION: NAME: ADDRESS: CITY: . . PHONE (DAYTIME: E STATE: ARCEL[TECT/ENGINEER INFORMATION: XT AA XU ADDRESS: CITY: PHONE (DAYTIME): STATE: ST. LUCIE CO CERT. #: FAX: FAX: ZIP: ZIP: ZIP: SLCCC: 9123109 Revised 0 7/17118 OFFICE USE ONLY: DATE FILED: L4 12,1 �203D REVISION FEE: V-7 15 PERMIT # 19 13- oll RECEIPT # b0e, PLANNING & DEVELOPMENT SERVICES BUILDING. & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772) 462-1553 APPL I [CATION FOR BUILDING PERMIT DEFERRAL � PROJECT INFORMATION LOCATION/SITE ADDRESS: 3 k ot DETAILED DESCRIPTION OF REVISIONS: CONTRACTOR INFORMATION: STATE ofFL REG./CERT. BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: -1 STATE: PHONE (DAYTIME): I OWNER/BUILDER INFO,RMATI,ON: r7c ST. LUCIE CO CERT. #: FAX: ZIP: NAME: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME: FAX: ARCHITECT/ENGINEER INFO I RMATION: NAME: ADDRESS: CITY: PHONE (DAYTIME): STATE: ZIP: FAX: SLCCC: 9123109 Revised 07117118