HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
��.j --1- BUILDING AND CODE REGULATIONS DIVISION
•
. _ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST APR 2 5 0018
ST. Lucie County, Permitting
PERMIT NUMBER: ADDRESS: 14 4a1YER _3Y*/
I, unw1oialic 0 -1 E ►Z�`� am requesting that the above permit be renewed. I
understand thatchedule 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
V,- ,- - --, I�2,,,� Oy-
O ER/BLD R CCOTRACTOR SIGNATURE DATE
t>MPUIo"4� yr-APj- f»r-ke-
Print Name
STATE OF FLOyj1A.L Jc `
COUNTY OF \
ACKNOWLEDGED BEFORE ME THIS a`5 DAY OF Q 1 20N�
BY V D�� v+x!�.Qt. 1A%V% P•N f -It— WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED L AS IDENTIFICATION.
TATE OF FLORIDA,County of I •^2 gip;AQ NA MtiRIE GIVENS
=2� MY COMMISSION#GG 022023
EXPIRES:December 16,2020
SIGNATURE OF NOTIRRY
otaryP96ALdelers
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