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REVISION-ELEVATOR
OFFICE USE ONLY: DATE FILED: �' �- i� ���b��d PERMIT # REVISION FEE: � RECEIPT #- PLANNING &. DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982.5652 (772) 462.1553 APPLICATION FOR BUILDING PERMIT[ _ff RRAkw PROJECT INFORMATION LOCATION/SITE ADDRESS: G 0 DETAILED DESCRIIPTION OF PROJECT CONTRACTOR INFORMATION: STATE of FL ./CERT. #; n q f 6 - ST. �LUCIE CO CERT. REG#: BUSINESS NAME: QUALIFIERS NAME: �k G e l Slt Annulr7ec- CITY:W~v STATE: ZIP: PHONE (DAYTIME): VA- �'� � FAX: OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: PHONE (DAYTIME: STATE: ARCHITECT/ENGINEER INFORMATION: TTATA(F- FAX: ZIP: - -- - ADDRESS:----- ---- --. _ .. - -------.- _ . -- --- - - CITY: STATE: - - PHONE (DAYTDAE): FAX: -- - SLCCC: 9123109 DEC 13 2018 Revised 07117118 Permitting Department St. Lucie County, FL