HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
""Y°� FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERM IT NUMBER: O �(
CIE, ,am requesting that the above permit be renewed. I
underAdnd that 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 during any six month period during the renewal period.
Justification IVO ��PC,,/t�i9f�i'' f/�/f 1)6Cej
OWNE DR OR CONTRACTOR SIGNATURE DATE
\/)�V(ZlA-00
Print Name
STATE OF FLORIDA
COUNTY OF S . UJZ\
.ACKNOWLEDGED BEFORE ME THIS DAY OF 20�a_
BY V % i,Ce v,* L\d� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED l, L AS IDENTIFICATION.
STATE OF FLORIDA,County ofEANNA MARIE GIVENS
C \
MY COMMISSION#GG 022023
SIGNATURE OF NOTAR EALEXPIRES-December 16,2020
%};pdF�;.•• onded Ttuu Notary Public Underwriters
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ 5` 6.06 Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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d•
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: -
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordin .our Notice of Commencement.
Signature of Own Lessee/Con actor as Agent for Owner Signatu e of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF k , Ly c COUNTY OF `�
The forgoing instrume t was acknowledged before me The forgoing instrumen was acknowledged before me
this 1u day of.- �A ,20Na by this day of 204. by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida) (Signature of Notary PAL-State of Florida)
Personally KnownRE
Personally Known beatification
Type of Identif ation DEANNAMARIEGNEN Type of Identification =;�'' ''i' D
,.••:�.tr .; ► MARIE Gpius
Produced . __ MY COMMISSION#GG 022023 produced �— �*= M►'COMMISSIO
S:December 16.2020 N
1're onded Thru Nota Pubrie Underwriters ••Rt;�4`•'•, Bonded 7hryS' em6er
Commission No. �'' Commission No, h IrcUnder„rte:: ;;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
:Fe-v-. 7/203.4
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