HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
I BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- -- — FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578RECEIVE D
PERMIT RENEWAL REQUES NOV 0 5 2018
ST- Lucie County, !'53rmitting
PERMIT NUMBER: l �I D �V� ADDRESS:—5—Do l ) �,�Ir��Itl► IL�1 `� l � �
I, en��5 ZGt(' , 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
OWNE)Z/EL �
OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDI
COUNTY OF -�T�_�j J��AY
d
ACKNOWLEDGED BEFORE ME THIS OF JQC bC�k- 20�
BY ! 1� � �WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
%GNATURE
JFPIK
f GA. �� cA C
��'`•�a y; COLEEN SULLIVAN
„ `= MY COMMISSION#GG071535
:�i•, r
Y S �',�o, qu�;. E=XPIRES 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
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