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HomeMy WebLinkAboutPROJECT INFORMATIONf � ,OFFICE USE ONLY: DATE FILED: 7b g REVISION FEE: -is- 00 PERMIT# /$oy% 63s3 RECEIPT # PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 IA AVENUE GPNN�� FORT PIERCE, NFL 349 2- 652 S `ge GOVSlt4 (772) 462-1553 St. APPLICATION FOR BUILDING PERMIT DEFERRAL PROJECT INFORMATION LOCATION/SITE ADDRESS: pp ' a0/o - �o/B .Sr /)02-f S-r Lucy &I'v8 . DETAILED DESCRIPTION OF PROJECT REVISIONS: _ ,CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: ES I ZOOO BUSINESS NAME: �aJ9E.L1�R9/av/+?L QUALIFIERS NAME: WILD Lj fiver fl. ADDRESS: IOT31 CA2�JMZ S? CITY: v STATE: PHONE (DAYTIME): OWNERIBUILDER INFORMATION: NAME ADDRI CITY: PHONE (DAYTIME: ARCHITECT NGINEE NFORMATION: NAME: C ADDRESS: CITY: PHONE(1 YTIME): 3c)3 a STATE: ST. LUCI CO CERT. #: o 996 6 Ap.. 'L I6 /a 5 l �,u ,I/_ ORPTSS 9 // • f _ ZIP: 33 -72 /7 FAX: FAX: FAX: SLCCC: 9123109 REVISjr%ma Revised 0616/3011/17WIM ZIP: