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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
`"` •_`__'_ FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
I
RECEIVED
PERMIT RENEWAL REQUEST SEP 2 7 ?018
ST. Lucie County, PermitGii?9
PERMIT NUMBER: 1803-0457 ADDRESS: 6611 Fort Pierce Blvd, Fort Pierce
I, Roderick Waller ,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 Owner was out of the country.
9/26/18
OWNER/BLDR OR CONT CTOR SIGNATURE DATE
RODERICK WALLER
Print Name
STATE OF FLORIDA
COUNTY OF ST LUCIE
ACKNOWLEDGED BEFORE ME THIS 26TH DAY OF SEPTEMBER 12018
BY RODERICK WALLER WHO IS PERSONALLY KNOWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
S ATE OF FPORIDA,C nt T LUCIE
Notary Pub6C Slate of FWrida
SICNATURE OF NOT Y &N Sophia Hartis
i1Ay Commission GG 43
i� M1 Expires 05r=020
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