HomeMy WebLinkAboutInspection Docs PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
* BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
NOV 0 12017 PERMIT RENEWAL REQUEST
PERMITTING
St. Lucie County, FL
PERMIT NUMBER: _
ADDRESS: (ZA
t-)a A
I,�j I r) C_`kF, J A G C__ ,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
andrstand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
pass g inspection during an six month period during t�p renewal p rind.
Justift ation SS — r4 LM ted`
OWNERBLDR OR CONTI;t-AcTOR SIGNATURE DATE
V1,MO'e,P1 sfw
Print Name
STATE OF FLO
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 06-4. ,20—a—
BY WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLRIDA, oi ty of
KAREN S. NIELSEN
SIGNATUREOFN AR ?• CommissiofERALF 115637
oma: My Commission Expires
June 12, 2018
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 = $*75.M Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014