HomeMy WebLinkAboutRenewal request PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
COUNTY
2300 VIRGINIA AVE RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
JUN 2 91019
Permitting pepartment
PERMIT RENEWAL REQUEST St, Lucie County
PERMIT NUMBER: ! C1 �J ADDRESS: -
I, -S c'0`1'J—& c e YL ,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
_ 3 -a 3
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
St o'n` P-r 2`t r5
Print Name
STATE OF FLORIDt>„
COUNTY OF
ACKNOWLEDGED BjEF0,RE ME TM DAY OF J�l��!/ 20A
BY 1411,- WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �LD L 5�Z��'j �„TLZL� y AS IDENTIFICATION.
ST TE OF FLORIDA,County of V �C�/�,
BELINDA DARDEN
Notary Public—Stale of Florida
SIGNATUkE OF NOTARY SEAL ; U' Commission tt GG 169025
=•'"�,� 4 ;�).'My Comm.Expires Dec 18,2021_
Hondod Ihmugh National Notary Assn.
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