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Home My WebLink AboutREVISIONOFFICE USE ONLY: DATE FILED: 4/z7 /u w REVISIONFEE: $75,00 LOCATION/SITE PERMIT# 1911—cAll RECEIPT# DUE PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DMSION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772)462-1553 lb C) APPLICATION FOR BUILDING PERMITDEFERM % PROJECT INFORMATION Icku"nploo; 'SICU 7:�tma DETAILED DESCRIPTION OF PROJECT REVISIONS: CONTRACTOR INFORMATION: STATE ofFL REG./CERT BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CrI'Y: PHONE (DAYTIME): STATE: OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: PHONE (DAYTRAE-- STATE: ARCIHTECT/ENGINEER INFORMATION: ST. LUCIE CO CERT. #: FAX: FAX: ZIP: U-1 'A ADDRESS: CITY: STREVISHRic ZIP. PHONE (DAYTIME): FAX: SLCCC: 9123109 co(k+pAckw- 7L) v(o.- 04�- ct-� 0-p rp;.-K Revised 07117118