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 RECEIVE D
PERMIT RENEWAL REQUEST JUL 2 6 2018
ST. Lucie County, Perrnittin0
PERMIT NUMBER: ADDRESS:
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 `,oZ 1SZ (Zi Cg(t- �o-t,b
M/
OWNS DR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORM
COUNTY OF \
ACKNOWLEDGED BEFORE ME THISQ_DAY OF c 1 U ISI 20
BY WHO IS PERSgWALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
l
STATE F FLO DA,Cotity f' U
,� �a
KAREN S. NIELSEN
o ��=State of Florida-Notary Public
SIGNATURE OF NOT Y SEAL ;�
*- Commission#GG 207484
�FOF�`aa° 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: r
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