HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
COUNTY
2300 VIRGINIA AVE
FORT PIERCE,FL 31982 _
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST MAR 0 9 2018
ST. Lucie County, Permitting
PERMIT NUMBER: �''��70�G�ADDRESS: hQ U� T�GZ\IeJ6
1, 011M ±, n ,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 "Ca'Y-%PX ),, i,AaLof
OWNER/BLD DaC T OR SIGNATURE D1kTE
�m
Print Name
STATE OF FLKJIPA
COUNTY OF M�
ACKNOWLEDGED BEFORE ME THIS DAY OF\ I lVu 20 �D
BY���t--40 IS PERS OWN TO ME�,OR
HAS PROVIDED �^ AS IDENTIFICATION.
STATE O FLORIDA,County of �� 2ac�
KIM A.STONE
SIGNATURE OF NOTARY SEAL ► MY COMMISSION k 2
EXPIRES:OctoDa 155,,201919
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 = $I� Renewal fee
Example: [15 divided by 23=,65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
:u,o,=l
ZOO/LOO"d Z04# OL=EL SLOZ/80/EO