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
MAR 0 7 2018 PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER:�I ,C10-1 - d)q ADDRESS:
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 during the renewal period.
Justification ��( ` 1�wl�
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FIL II?A
COUNTY OF \CY1
ACKNOWLEDGED BEFORE
-ME THIS DAY OF�K-Gh 20W
BY M Cb-44,n WHO IS PE LLY TO ME OR
HAS PROVIDED (� l_ AS IDENTIFICATION.
STATE OF LORIDA,County of
SIGNATURE OF NOTARY gg 'L=9008Z6AA:#N01&S1V4K')-)AW
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
ZOO/Zo0'd 66v# 60=60 13L0Z/90/E0 -wo.�