HomeMy WebLinkAboutBuilding Permit Application (2) PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
J BUILDING AND CODE REGULATIONS DIVISION
• •: 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
NOV 282017
PERMIT RENEWAL REQUEST PERM117ING
St. Lucie County, FL
PERMIT NUMBER:�(� �,����'D,,S�>ADDRESS: ���C� �I ✓j.� �� 1 /&W r��f�� ce
1, no GO Yl'I �07 T/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 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
y
R/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORI A
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF N� 20 (7
BY __77,A(,10 B 1+STii WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STALAFN
RIDA,County of
T—�� �►"'' JANET ROSSIGNOL
MY COMMISSION#GG144620
OTARY SEAL EXPIRES October 21,2021
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: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014