HomeMy WebLinkAboutPermit Renewal r ..w L ;� ,:'Agri '
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION..
WHA 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST MAR.2 8 1010
Permitting Department
St.Lucie County
PERMITNUMBER: l 0-7 'n377 ADDRESS:
I, o � ,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�c i v
OWNE R CONTRACTOR SIGNATURE DATE
Print 1,1ame
STATE OF FLORIDA
COUNTY OF 5+ Lo G�-e
ACKNOWLEDGED BEFORE METHIS DAY OF r A 0d-.r—'Vx .20
BY �( I ll�L WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of S LU G,;-C
SIGNATURE OF ROTARY SEAL HEATHER RURF0RD
State of Florida-Notary Public
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•= Commission # GG 183217
Mv[�ommiccing FXpirAS
---~--1— ~--��---- i "� February 06, 2022
FOR OFFICE USE ONLY:
Number of Open Inspections: 1z_
TotalInspections:
(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