HomeMy WebLinkAboutUntitledPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
$"LrP16 J' BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RE EWER
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 MAR A R 2018
permitting [)eluent
PERMIT RENEWAL REQUEST St. Lucie Count''
PERMIT NUMBER: 00 /17 33 ADDRESS: (o��OS �ASp �Z�\e-.S �1 Usk
I, Jos-�P`rl 7e.oar,,- , 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 re,vc.- ijas N,,4f.0-151"l =
OWNERBLDR OR CONTRACTOR SIGNATURE
0o s
Print Name
31W ,
DATE
STATE OF FLORn LU
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _ DAY OF M , C til 20
BY SOSG 'C-f—n 0 fl X_ WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED r L AS IDENTIFICATION.
STATE OF FLORIDA, County of '5+ 1—Jf. , L _
�HEATHER BURFORD
101 'T `v- State of Florida -Notary Publi
SIGNATURE OF NOTARYSEAL n Commission a GG 183217
FW' My Commission Expire,
�' February 06, 2022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: )U» x % open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014