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HomeMy WebLinkAboutPROJECT INFORMATION (2)OFFICE USE ONLY: DATE FILED: REVISION FEE: LOCATIONISITE PERMIT# - RECEIPT # PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE SCIA//V, FORT PIERCE, FL 34982-5652 St. S (772) 462-1553 ktoa C007ty 'APPLICATION FOR BUILDING PERMIT DEFERM PROJECT INFORMATION DETAILED DESCRIPTION OF PROJECT REVISIONS: CONTRACTOR INFORMATION: STATE ofFL REG./CERT. BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: PHONE (DAYTIME): — STATE: OWNER/BUILDERINFORMATION: Iff"ITI CITY: STATE: PHONE (DAYTIME: ARCHITECT/ENGINEER INFORMATION: NANIE: ADDRESS: CITY: PHONE (DAYTIME): SLCCC.- 9123109 Revised 07117118 STATE: ST. LUCIE CO CERT. #: FAX: FAK: FAX: ZIP: ZIP: ul-03 OFFICE USE ONLY: DATE FILED: REVISION FEE: LOCATION/SITE PERMIT# RECEIPT # PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772) 462-1553 APPLICATION FOR BUILDING PERMIT DEFERRAL PROJECT INFORMATION DETAILED DESCRIPTION OF PROJECT REVISIONS: CONTRACTOR INFORMATION: STATE ofFL REG./CERT. BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: PHONE (DAYTIME): STATE: OWNER/BUILDERMORMATION: XT A A/M - ADDRESS: CITY: PHONE (DAYTIME: STATE: ARCHITECT/ENGINEER INFORMATION: NANE: ADDRESS: CITY: b PHONE (DAYTIME): STATE: ST. LUCIE CO CERT. #: FAX: FAK: FAX: ZIP: VA rJ PAIS SLCCC.- 9123109 Revised 0 7117118 OFFICE USE ONLY: DATE FILED: REVISION FEE: PERMIT # RECEIPT # PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772) 462-1553 APPLICATION FOR BUILDING PERMIT DEFERRAL PROJECT INFORMATION LOCATIONISITE ADDRESS: DETAILED DESCRIPTION OF PROJECT REVISIONS: CONTRACTOR INFORMATION: STATE of FL REG./CERT. #: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: PHONE (DAYTIME): STATE: OWNER/BUILDER INFORMATION: NANIE: ADDRESS: CITY: PHONE (DAYTIME: STATE: ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: PHONE (DAYTIME): STATE: ST. LUCIE CO CERT. FAX: FAX: "'k ZIP: K "I, WO SLCCC: 9123109 Revised 07117118