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
MAY 18 2018
PERMIT RENEWAL REQUE T
ST. Lucie County, Permitting
PERMIT NUMBER: 5 Z — 0O bt' ADDRESS: TJ 60 S- LjjyLd (A,,24 4
am requesting that the above permit be renewed. I
understand that I musts edule 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 durin any six onth period duringhe renewal period.
Justification
5WNERYBLDR 611 CONTRACTOR SIGNATURE DATE
Qj )CT a6S�L��r
Print Name
STATE OF FL.O
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20-d—
BY ( ,��� D5 p LriY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLO D ounty VI 'T r'
ti�AyPU%, KAREN S. NIELSEN
�r
SIN TU ;OF AR , State of Florida- �y Public
'? Commission # 2%7484
',rFp My Commission Expires
June 12, 2022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage: i1 �1
Original permit fee: x%open = $ Renewal fee V" e
Example:- [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014