HomeMy WebLinkAboutPermit Renewals 05-01-18;20; 52 ;From: To:7724621578 ;7724618722 # 2/ 3
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
BOOM
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST MAY 0 2 2018
ST. Lucie County, Permitting
PCRNIITNUMBER: ADDRESS:�,�_Z Q f 4s��0._.._..Ct
I. C1�d c1,�,(�___(�1.Q�4� ,am requesting that the above permit be renewed. I
understa d that 1 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
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�RERW/BLDR Ql�CONTRACTOR SIGNATURE . DA
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Print Name
STATE OF FLORIDA
COUNTY OF S7—
ACKNOWLEDGED
TACKNOWLEDG1 D SLFORE ME THIS DAY OF —.20
BY � � gt% WHO IS PERSONALLY KNOWN TO ME V' OR
HAS PROVIDED AS IDENTIFICA'T'ION.
STATE OF FLORIDA,County of �7% �/e/� Ov-
SUSANMONTENEGRO
:�� MY COMMISSION#GG 089099
EXPIRES:ADrll 2.2021
TG ATURE OF NOTARY ,fir °'r Naar Pok Lkld Itms
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections,
(Divide open by total to get%of open inspections)
Percentage: i
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23.65(%)) $175(permit fcc)x.65=$l 13.75(renewal fee)
Revised 7/21/2014