HomeMy WebLinkAboutREVISIONOFFICE USE ONLY:
DATE FILED: % n?3 ' 1
REVISION FEE: �J
PERMIT#
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
SCANNED
FORT PIERCE, FL 34982.5652
BY
(772) 462.1553
St. Lucie County
APPLICATION FOR BUILDING PERMIT DEFERRAL
PROJECT INFORMATION ii
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DETAILED DESCRIPTION OF PROJECT
REVISIONS• _
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CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #:
BUSINESS NAMF.
QUALIFIERS
ADDRESS:
CITY:
PHONE (DAYTIME): FAX:
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME:
STATE:
ARCHITECT/ENGINEER INFORMATION:
ME"
L1Y:
ZIP:
NAME: G6
ADDRESS:
CITY: u, - 375 - STATE: ZIP:
PHONE (DAYTIME): FAX: f c3 I ra
5LCCC: 9123109
Revised 06130/17
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