HomeMy WebLinkAboutrevision wire lathOFFICE USE ONLY: l / /1 I� )
DATE FILED: Ca ' / PERMIT # l qy 7— 0 / & S-
REVISION FEE: '- \ to b RECEIPT #
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PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE File COPY
e�� FORT PIERCE, FL 34982.5652
ePat� ' (772) 462.1553
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APPLICATION FOR BUILDING PERMIT REVISION
i PROJECT INFORMATION
LOCATION/SITE
ADDRESS: c <
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DETAILED DESCRIPTION OF PROJECT
REVISIONS: tt
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: CSC. % S 2 '-1 Z 5S0 ST. LUCIE CO CERT. #:
BUSINESS NAME: LA!S L J 1B � �01ba &A canna Cey\ g wri-cv.>
QUALIFIERS NAME: q nAn, o Lc .�?�-r
ADDRESS: LI, L0 C7 S OG vk t-%3�A 1-
CITY: (-o 2'r p o cLt STATE: '(- L ZIP:
PHONE (DAYTIME): 7) � Z 359 LID 6a FAX:
OWNER/BUILDER INFORMATION:
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NAME:
I' ADDRESS: aGoo (—qPs0c- ZIP: 3
CITY: r-o A.k Q c� co- STATE: _ LF q
PHONE (DAYTIME: 65- IA3 G 2t FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS: _
CITY:
PHONE(DA
SLCCC: 9123109
Revised 06130117
101