HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• - 2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
FEB 2 12018
PERMIT RENEWAL REQUEST
ST. LuCle County, Permitting
PERMIT NUMBER: O 1 ADDRESS: ss _bffO_r LAt r� r
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 durin the renewal period.
Justification
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS1 DAY OF 20,
BY t�- ,v�r��J _l WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED _ AS IDENTIFICATION.
4TAE OF O DA,Cou o ��l�
cr —�
SIGNATURE NOTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections) """ KAREN S. N I E L S E N
Percentage: Commission# FF 115637
Original permit fee: x%open = $ ,� Renewal fee :�a My Commission Expires
OF F1;.� June 12, 2018
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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