HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
COUNTY
. 1 0 AI 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(� (772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
JUL 2 S X2017
PER[lilT 1NG
St. Lucie co ty, FL
PERMIT NUMBER: ` lQ 12-0506 ADDRESS:
l• LIQ �Z
I, ri AA r\ ,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.
Justifications
07P4R OR ONTRACTOR SIGNATURE DA
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Print N e
STATE OF FLO D
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS ���j DAY OF�5���1�p 20J'7
BY 4(� C. 1�� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
ILI
I<AREN S. NIELSEN
W/ -- Commission # FF 115637
SIGNATURE OF NOTARYMy� mission Expires
�' 9u e 1 2018
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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 = $ Renewal fee
Example: [1.5 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014