HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 n V A^
(772)462-1553 Fax(772)462-1578 wY E D
NOV 0 6 2017
PERMIT RENEWAL REQUEST PERMITTING
St. Lucie County, FL
PERMIT NUMBER: �(�'� (/�2-I ADDRESS: -7604o A� �YSdd, OY7 P F-L
I, P h n � VL-erre am requesting that the above permit be renewed. I
understand that I must sche ule 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 m4 t Ce-
OWNER/BLDR OR CONTRACTOR SI ATURE AT
�hery b h�� s arta
Print Name
STATE OF FLORIVA
COUNTY OF I
ACKNOWLEDGED BEFORETHIS _DAY OF (`)V . 20-
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF LORI A,Countyo """ KAREN S. NIELSEN
...,
Commission k FF 115637
�--'` My Commission Expires
SIATURE OF NOTARY '%'�ur��° AL 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 = $ 416-
Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014