HomeMy WebLinkAboutPermit Renewal Request04/01/2018 16:36 1772331" °r8 PAGE 01/01
A MONISM I PLANNING AND DEVELOPMENT S1EiXtVXCES pEpAR'pNIEN'X` .
BUILDING AND CODE REGULATIONS DIVISION
2300 VMGINIA AVE RECENED
FORT I'1ERCE, FL,34982
(772) 462-1553. Fax (772) 462-1578
APR 0 2 2010
PERMIT RENEWAL REQUEST Permitting. Department
St. Lucie County
r Nvn�R: �'tio"1 .. ADDRESS:
am requesting that the above permit be renewed. I
nd that I must schedule and pass all required inspections for the permit to be fi naled. Further, I
end that this is a ONE TXN[E RENEWAL and the permit shall expire should i not -receive a
inspection during any sip Aaonth period during the renewal period.
e
CONTRACTOR SIGNATURE
46 got g
DATE
F int Nome
$ rATE OF FLORIDA
trNTY Oli ilg i t nr �./
20
KNOWLEDGED BEFORE' ME THIS DAY OF 1
C f_b
�s % y�i �11 1�_/ WHO IS PERSONALLY KNOWN TO MT. OR
A5 PROVIDED 4 AS IDENTIFICATION.
rATE OF FI.ORIDA, County 0f„' �/% T 41
f MY COMMISSION #FP38t881
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