HomeMy WebLinkAboutAPPLICATION FOR PERMIT REVISIONOFFICE USE ONLY:
CANNE®
DATE FILED: BY
REVISION FEE: St Lucle County
LOCATION/SITE
ADDRESS:. „ _
PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
12300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5652
(772) 462-1553
APPLICATION. FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
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DETAILED DESCRIPTION OF PROJECT,
REVISIONS:
S� ►y,G u-�e �� is Spec sLe tl -Ce r '2 0 Ito,5
CONTRACTOR INFORMATION:
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STATE of FL REG./CERT. #: fi L r `7 ST. LUCIE CO CERT. #:
BUSINESS NAME: '
QUALIFIERS NAME:
ADDRESS: li
CITY: o<�,- ; 2 rG� - � STATE: r L-- zip: �3 yy s
PHONE (DAYTIME): -7 7 2 - C?&- /p4 $ FAX: 7 72 - ,3/ S - 6aCQ 7 A
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OWNER/BUILDER INFORMATION:
NAME:
ADDRESS: ii.
CITY: I STATE: _
PHONE (DAYTIME:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME):
SLCCC: 9123109 i
Revised 06130/17
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ZIP:
ZIP: