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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE,FL34982 (772)462-1553 Fax(772)462-1578 PERMIT RENEWAL REQUEST PERMIT NUMBER: / �y� ✓�� ADDRESS"A1119 1V f © Ave I, am requesting that the above pc;iAitbe re en wed. I understan ffiit must schedule and pass all required inspections for the permit to be finaled. Further, I understand at 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 renwal period. Justifi tion C I. OWNERS R CONTRACTOR SIGNATURE DATE Print N STATE OF FLORIDA COUNTY OF ACKNOWLEDGED BEFORE ME THIS _DAY OF BY CTe �? ��, L&WHO IS PERSONALLY KNOWN TOME ,OR HAS PROVIDED AS IDENTIFICATION. STATE OF ORID County of 1 w SIGNATURE OF NOTAV. SEAL FOR OFFICE USE ONLY:��p����M� 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(0/o)] $175(permit fee)x.65=$113.75(renewal fee) N. .vaXVED Revised 7/21/2014 AUG 21 .2018 Perr�ii�ting Ue n� {;len St Lucie County, FL