HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
i UNTY BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED.
(772)462-1553 Fax(772)462-1578
NOV 0 8 2018
PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: 1 ADDRESS':
I, OA I/]D #WVQ1-A ,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
1A
O O TOR SIGNATURE DATE
17 ID 1761
Print Name
STATE OF FLORIDA
COUNTY OF �'
S I
ACKNOVFDGED B FO THIS�_DAY OF D r/{ �f pr— 20
BY 61(� �YU1/il� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED
X."' AS IDENTIFICATION.
rr
STA ORID County of 1 WY `1 "� �G �pKy Erich Daniel Krach
a� o� NOTARY PUBLIC
STATE OF FLORIDA
SI OF NOTARY SEAL ` ' i Comm#GG105925
El eExpires 5/17/2021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage: i
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
•Sn<s: .