HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
10'! 052018
PERMIT RENEWAL REQUEST sT. Lucie County, Permitting
PERMIT NUMBER: I 0 ADDRESS:r�`'I v-1 � ja
I, '>n1\lS ZaC 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
OWNER/BLIO OR CONTRACTOR SIGNATURE DATE
I _nn15 2-aceK
Print Name
STATE OF FLORID
COUNTY OF �f_C� �
ACKNOWLEDGED BEFORE ME THIS QnAY OF
BY �� tMet WHO IS PERSONALLY KNOWN TO ME Ll--' ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORID Aof e , Lu �f ��- G,OLEEN SULL1V�gNGNATURE OF t_
SE o�r MY COMMI38ION#GG071535
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
IL4JO —S7 -5`7Co.13