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// G St. Lucie County
PERMIT# Il0 5 ' O�
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
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CONTRACTOR INFORMATION:
STATE of FL REGJCERT. #:
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OWNER/BUILDER INFORMATION:
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Revised 0722/2014
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ST. LUCIE COUNTY
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FOR CODA 1 CE
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ZIP:
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RECEIVED NOV 012016
OFFICE USE ONLY: `
DATE FILED: \ \ I 1 1 \c
REVISION FEE: lry -1 -:�
1. LOCATION/SITE
ADDRESS: M
PERMIT # 1605 ' 0922
RECEIPT # „% %1
PLANNING & DEVELOPMENT SERVICES SCANNFp
BUILDING & CODE REGULATION DIVISION Sr ey
2300 VIRGINIA AVENUE �UCie C
FORT PIERCE, FL 34982-5652 oufjty
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
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2. DETAILED DESCRIPTION OF PROJECT
REVISIONS:
3. CONTRACTOR INFORMATIOONn::
STATE of FL REG./CERT.
BUSINESS NAME: �-
QUALIFIERS NAME•
ADDRESS:
CITY:
PHONE (DAYTIME):
4. OWNERBUILDER INFORMATION:
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NAME:
ADDRESS:
CITY:
PHONE:
NAME:
ADDRESS:
CITY:
PHONE(DA
Revised 072212014
COUNTY CERT. #: 2 561 5q
STATE: �- ZIP:
FAX: ii2'4(o%-//oZy
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