HomeMy WebLinkAboutPermit Renewals �L PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
o - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE s / w;l F
Fowl*PIERCE,FL 34982 1 '>a
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST PER,,0i,-(TINIG
St.Lucia County, FL
PERivllT NUMBER--5L0— 1 art 11= C) L4%\ DRESS: 5-1,3'P, s�l�Ss?�"��
1, Q{M'tPS —x.y��_,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finated. 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 -� �� '�„t Ca �' — L2 P - f � G (Z t*jTyt-1 „jr. T S
g\,�NER/BLDR®R CONTRACTOR SIGNATURL; DATr
Print Name
STATE OF FLORIDA
COUNTY OF '4?�ea(a
ACKNOWLEDGED BEFORE tUIE T141S J DAY OF�-TO k)
t3Y, MC'S -�✓'�_� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDL'D AS IDENTIFICATION.
STATE OF LORIDA.County or M Beac/,I
�o,�pRYPUg�� ANGEi.AYOUNG
S GNATU —OF/ 1:4RY SEAL MY COMMISSION#FF 951669
Npt = qz EXPIRES:Apri112.2620
TFpF�yoQ' Bcndod7hru6udgEtNotaySerrices
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: t15 divided by 23=.65(%)J $175(permit ree)x.65=S 113.75(renewal fee)
Revised 7121/2014