HomeMy WebLinkAboutPermit Renewals 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
NOV 0 5 2018
PERMIT RENEWAL REQUES ST, Lucie County, Permitting
PERMIT NUMBER: A. D3 ADDRESS ��� ` ����1 ► ���•
I, en�IS Zoe'e K , 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
I1 � 1�
OWNER/BLMV OR CONTRACTOR SIGNATURE DATE
1�11h15 Zaw
Print Name
STATE OF FLORID IJ�
COUNTY OF �,�'L Ind.
ACKNOWLEDGED BEFORE ME THIS fnAY OF jQCNEM20AZ_
BYanfl tl*QK WHO IS PERSONALLY KNOWN TOME I/ OR
HAS PROVIDED ` p AS IDENTIFICATION.
S OF FLORID o f , t_UCA ]eRY'.�eL; GOLEEN SULLIVAN
MY COMMISSION#GG071535
'� -
oF /0 EXPIRES February 09,2021
GNATURE OF ARY SEAL ��
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