HomeMy WebLinkAboutREVISIONOFFICE USE ONLY:
DATE FILED: t
REVISION FEE: 00
SCANNEL,
BY
St. Lucie Count
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1
PERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DMSION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553 FAX (772) 462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
1. LOCATION/SITE , U 6 b 3- I Deb q 5.
ADDRESS:
34a51
2. DETAILED DESCRIPTION OF PROJECT
(tiXN Ih P I"
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: CI�I
BUSINESS NAME:
QUALIFIERS NAN�E:
ADDRESS: 1 n 01-5 f
CITY: ;
PHONE (DAYTIME): 'Y) Y 23
4.
5.
INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE:
NAME: SL
ADDRESS: nor
CITY: S
PHONE (DAYTIME):
Revised 07=014
INFORMATION:
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STATE:
FAX:
STATE:
VI Y,L )-�A � I
COUNTY CERT. #:
ZIP:
(=L
ZIP::i4llb l-