HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• J BUILDING AND CODE REGULATIONS DIVISION
TY
_ 2300 VIRGINIA AVE
RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
APR 18 2018
PERMIT RENEWAL REQUES ST. Lucie county, Permitting
PERMIT NUMBER: 1 D U O`� �1' ADDRESS: Mon� e
i, 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 V0 y'o&Cb
WNER/BLDR OR CONTRACTOR SIGNATURE DATE
o s �k P FYlcmC-0-6
Print Name
STATE OF FLORIDA
COUNTY OF y
ACKNOWLEDGED BEFORE ME THIS 1/ DAY OF /S�/Ji��� 2017
BYE/�i WHO IS PERSONALLY KNOWN TO MEQ OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FJORIDA Co of
i,,pY PU••,, RICHARD F.KREBS
:°, 't� Notary Public-State of Florida
SIG TURE O NOTA Y S ' Commission kGG075137
My Comm.Expires Apr 26,2021
' xF1'�?;;•. BondedthraughNationalNotaryAssn.
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