HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
' BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
AUG 10 2017
PERMIT RENEWAL REQUEST PERf011_i"ING
St. Lucie County,FL
PERMIT NUMBER: SU, -1?0I— 02S7- ADDRESS: SBO(o PRPR 7a F+ • PlEgef— rt-3yo2
1, QjLA4 L-0 ,am requesting that the above permit be renewed. I
understand that must•schedu a 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 Fp -T-�Z-4,
10 i6 1
O CONTRACTOR SIGNATURE AT
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Print Name
STATE OF FLO A
COUNTY OF41
ACKNOWLEDGED BEFORE ME THIS DAY OF Q, 20jj_
BY ` �( � `P�� ( WHO IS PERSONALLY KNOWN TO ME ,OR
y
HAS PROVIDEDAS IDENTIFICATION.
STATE F FLO Coun o q
KAREN S. NISEN
SIGNATURE NO ARY 1116
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c.
.ts.
Commission# F 637
My Commission Expires
''� June 12, 2018
------------------------------------------------------------- r -e _rte .v -----------------------------------------
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections: O
(Divide open by total to get%of open inspections) `®
Percentage: I
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(1/o)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014