HomeMy WebLinkAboutPermit Renewals r6alg-
PLANNING
AND DEVELOPMENT SERVICES DEPARTMENT
g BUILDING AND CODE REGULATIONS DIVISION _
2300 VIRGINIA AVE RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
APR 3 0 2018
PERMIT RENEWAL REQUEST ST. Lucie County, Permitting
PERMIT NUMBER: O U I ADDRESS: —I_`Q� SCa rn� S 0 Q
I, f�S�*,e�.4 ,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 TO Q.,e-�— 1 4-1%
Cj
VIZ5,0 �0 2,
6 1
OWNER/BLDR OR CONTRACTOR SIGNATURE DA E
Print Name
STATE OF FLORIDA
COUNTY OF • L U C-')
ACK OEDGED BEFORE ME THIS�DAY OF (�--P r ' 20
BY WLI WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE LORI County f
...... omKARErn!s S. NIELSEN
``
Comm ss on a FF 115637
SIGNATURE 0 OT RY SE o 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 = $_75_Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014