HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
- i BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUE T
�' �Y L 3 ��18
ST. Lucre County, Permitting
PERMIT NUMBER: � d aly ADDRESS: 53 S 3 7fh 24
[, , nGnn-le, 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 4,- SG�fc1� �c �•„�,l ;.,Vee ,=�
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
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6lon7�ir�<2 �'
Print Name
STATE OF FLORIDA
COUNTY OF :!Qr -%- x�
ACKNOWLEDGED BEFORE ME THIS DAY OF )"N 4y 201
BY *SC a,n 6'%0 f% Cta tlxZo \*,Z WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED Q L' AS IDENTIFICATION.
STATE OF FLORIDA,County of — •o -
`: DEANNA MARIE GIVENS j
*: *: MY COMMISSION#GG 022023 lid
SIGNATURE OF N ARY P F-XFNR%:December 16,2020
Bonded Thru Notary Public Underwriters
--------------------1------------------------------ ---
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