HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
2300 VIRGINIA AVE.
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
SCANNED
BY
PERMIT RENEWAL REQUEST St. Lucie County
PERMIT NUMBER: AP-62-
_ U 2-2-Ce ADDRESS: % z [
I, & am requesting that the above permit be renewed. I
understand hat I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection within the renewal period.
Justification
F�
SIGNATURE
limy UO�IAI� A&i V&-
Print Name T �Q " (off rJ ^ S O 2-
STATE OF FLORIDA
COUNTY OF 6� . L,o
6111/zs
DATE
Q'A V QvAR.Y\V, C�r�
ACKNOWLEDGED BEFORE ME THIS �� DAY OF
20 s
BY �A V\y V 4�^�' Web C '\4\ SC WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, County of
SIGNATURE OF TARY
DFAN GIVENS
M1'COMMISS10RpRyft52
EXPIRES: January28 Y029
FOR OFFICE USE ONLY: Approved for 90 Days _ 60 Days _
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
2300 VIRGIlYIA AVE.
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ! �6 Z ^ U ZZ� ADDRESS: % 2' / w
,' , • ''m-
I, -PMW hA 6Q� Ul— am requesting that the above permit be renewed. I
understand�thlat II must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection within the renewal period.
Justification tt , �21M�nT �ylA� �
69C"ZF.11l9l3r4
AA Ua,.y�de-Ay v�
Print Name T 4Q ; gas - s 8 z-
STATE OF FLORIDA
COUNTY OF Sac. LotcP,,
�5/Iilzs
DATE
ACKNOWLEDGED BEFORE METHIS DAY OF V\ , 20 Z,5
BY tA WIN, V 4+�� %4 0 f A \C WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED
STATE OF FLORIDA, County of 5 \ Ac e
i
SIGNATURE OTARY
FOR OFFICE USE ONLY:
AS IDENTIFICATION.
DEANNAGIVENS
MrCommisslon # M SS8452
�'��ary28, 2028
Approved for 1 90 Days _ 60 Days —