HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST MAR 0$ 2018
ST. LUCIe county, permitting
PERMIT NUMBER/70`5'�5y/ ADDRESS:
1, Ae L5/1 42 ,am requesting that the above permit be renewed. I
understand that I rfiust 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 x month period during the renewal period.
Justification /il/p / �/ ,i ,�d��
OWNER/BLDR OR CON CTOR SIGNATURE DATE
xlzlle
Pnnt Name
STATE OF FLO
COUNTY OF
ACDGED BEFORE ME THIS -3 DAY OF
BYOWLEl� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLDA,Co ty of
U—� a�pY'IyB�j� KAREN S. NIELSEN
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SI ATUREOFNO AR S = Commission 1 FF 11563
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My Commission Expires
June 12, 2018
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 = $ 1 DQ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/212014