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
APR 2 3 2018 PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: _ �3 ADDRESS: ��
1, p / yri'Yt�r ,am requesting that the above permit be renewed. I
unde'rs and that I must schedfile 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
OWNERBLDR OR CONTKACTOR SIGNATURE DATE
llldeJ
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF rl 20—ti—
BY Y NA .1, M U Y Y—Y WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF LORI ,County o LTJ V
SIGNATURE OF O Y KAREN SC�n,(ITIELSEN
_ CornmissiorS ' 115637
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 = $ _Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014