HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
w 2300 VIRGINIA AVE RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
FEB 2 6 2018
PERMIT RENEWAL REQUEST ST. Lucie County, Permitting
PER NUMBER: 9 ADDRESS: ! J z,Nom— �L Y"
I, ,am requesting that the above permit be renewed. I
under 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 duri g any six month eripd during the renewal period.
Justification 0
OWRSVF1KM OR NTRACTOR SIGNATURE DATE
Print Name
STATE OF FLO
t )CIE
COUNTY OF
ACKNOWLEDGED 1 ORE ME THIS DAY OF 20j
BY "W tS 1 J� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE O FLORI ounty o ARR S. N I E L S EN
KEN
,s°•••
��,_ a Commission t1 FF 115637
My Commission Expires
SIGNATURE O O' Y SEAL 'z�„` a�,c dune 12 2018
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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 = $ ( Le. Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014