HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
' - Lz-1-2-41 BUILDING AND CODE REGULATIONS DIVISION
4. 2300 VIRGINIA AVE
1 FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
DEC 2 7 2017
PERMIT RENEWAL REQUEST PEr,M1171NG
St. Lucie Co::rtty, F':.
PERMIT NUMBER: ` ` —05" 1 ADDRESS: Oy IQ Dr00k �Q, tlL
I, V PA\) , \4 b Skins ,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�an six month riod during the renewal period.
Justification tExSR1 R t'�'�1
oV,rNFR/BLMNOR CONTRACTOR SIGNATURE DATE
v\v'�qyY�
Print Name
STATE OF FLO
g.
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF (1�C'�c 20
BY % 61 � WHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED EL DL AS IDENTIFICATION.
STATE OF L A,Co ty f """" KAREN S. NIELSEN
Commission# FF 115637
SIGNATURE OF TAY 12, 2018
My �,(�mission Expires
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=$1 13.75(renewal fee)
Revised 7/21/2014