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 2 3 2018
PERMIT RENEWAL REQUEST ST. Lucle County, Permitting
PERMIT NUMBER: 1-4 V I—T`f-' ADDRESS: 1 l �-F� �l� CL
�
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 � t
3- 1 q
OWNER/BLDR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF S x, L 3 c,0-
ACKNOWLEDGED BEFORE ME THIS�3 DAY OF �` 20
BY 7SX�E Vt`,�� `r WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �^ �L AS IDENTIFICATION.
11*�STATE OF FLORID County of �'. Ly� e
`•�''r°'.�'':-_ DcANNAArU1R1EC314'r';S
-M F; MY COMMISSION#GG 0Y1ijo'
SIGNATURE OF NOTA °`' gonEXPIRES:
dPthru Notabw ry Pubno
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