HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
�q ,"� BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
_. FORT PIERCE,FL 34982 "D
4982k' ESI 'pip
"° :I2 Lam,l�
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST MAR 0 6 2017
PEH!.41771J�G
St. Lucie County, FL
PERMIT NUMBER: ti' U? -U_j 7U ADDRESS:
1, ,t`y ,.n !/ S/c, t�O J ,am requesting that the above permit be renewed. I
understand 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 /6,-5o7 Iy Cc.
d-r �
O ERBLDR OR CONTRACTOR SIG�jNATTU�RE DATE
Print Name
STATE OF FLOIEJA
COUNTY OF
ACKNOWLEDGED BEFORE E THIS _DAY OF W jn yV)A_ 201171--
BY ��,� —WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED _ � � AS IDENTIFICATION.
STAT OF FL DA,Coty
KAIZEN S. NIELSEN
Commission# FF 115637
' •�` •-
SI TU T Y q My Commis xp es
June 12 18
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections: w
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014