HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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,COUNTYBUILDING AND CODE REGULATIONS DIVISION
' F LORI - 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUES JAN '2 4 2018
ST. Lucie County, Permitting
PERMIT NUMBER: I 't�oa ADDRESS:_2'(pcO S O ceo-r-) br.
1, ' ,am requesting that the above permit be renewed. I
understand th t must schedule and pass all required inspections for the permit to be finaled. Further, I
understand tha is is a ONE TIME RENEWAL and the permit shall expire should 1 not receive a
passing inspection during any six month period during the renewal period.
Justification
1
�'� 1 0311 S
OWNS R OR CONTRACTOR SIGNATU ATE
Print Name
STATE OF FLORI A
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS,,23` 'DAY OF .20
U
BY ����Q nT[ �Q� WHO IS PERSONALLY KNOWN TO MEOR
HAS PROVIDED AS IDENTIFICATION.
S ATE OF FLORIDA,County of ��. L�p 'Q— tra Pce'�,, DEBORAH RUSSELL
Notary Public -State of Florida
` = Commission # FF 179630
SIG17ATUR.E OF NOTARY o�` My Comm.Expires Nov 30,2018
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 = $ Renewal fee
Example: (15 divided by 23=.65(%)] $175(permit fee)x .65=$113.75(renewal fee)
Revised 7/21/2014
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