HomeMy WebLinkAboutPermit Renewals 11-15-18;00:44 ;From: To: 17724621578 ;7724618722 # 1/ 2
PLANNING AND DEVELOPMENT SERVICES D)CI PARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
RECEIVED (772)462-1553 Fax(772)462-1578
NOV 15 2018 PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: N0 1;-Q.1°l '6 ADDREss:-_-G1'7 e e A k{sm kr �7 r' r
am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be l na.led, 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 C-IX,%i-PT6.9_�C Ul_7-a S 111 a �" a vCL l a„
r f
0WNER/131rD CON CT S 'URE AT
Print Name
STATE OF FL0.1113A.
��-p —
COUNTY OF Li
ACKNOWLEDGED BEFORE ME THIS DAY OF \LbV ►'✓ � .20
I3Y �i/V�f A" `I "P WHO TS PERSONALLY KNOWN TO ME�=OR
HAS PROVIDED r rr AS IDENTIFICATION.
ST OF 4R1D ,County of
CHRISTINE CULPEPPER
MY COMMISSION#GG 061780
91GNATUP,T.6FNOThRY I SEAT, EXPIRES:January 11,2021
K g��`' 9otdOd That NOaMy PtIbIiC Undenvtl�ats
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 = S Renewal;Fee
Example: (15 divided by 23®.65(%)) $175(permit fee)x.65=$113.75(renewal fee)
Rcvj=17/21/2014