HomeMy WebLinkAboutPermit Renewal IV
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 AUG 2 7 7018
Permitting Departme,
PERMIT RENEWAL REQUEST St. Lucie county
PERMIT NUMBER: ISO I— 4 A J 3 ADDRESS:l Ip I \c-J '&\6.
I, eyl n 1'5 & ,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 Cu,' or r two_tS Out `}De )LA)(� +br CD
rrn Oc -lhS .
�`Z-i 1201
OWNER/BUDR CWCONTIXACTOR SIGNATURE DATE
17ennIS --ZaLa'e—k
Print Name
STATE OF FLORIDA
COUNTY OF ST• C�
ACKNOWLEDGED BEFORE ME THIS [M,DAY OFAiwan5b20-1*—
Ij
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
(1A'E FLORIDA, o nt f
COLEEN SULLIVAN
SI ATURE O SEAL �; MY COMMISSION#GG071535
•,�;';p� EXPIRES February 09.2021
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