HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVE D
PERMIT RENEWAL REQUES DEC 0 5 2018
ST. Lucie County, Permitting
PERMIT NUMBER: (P 3-02-u--? ADDRESS: 1�702— � oye
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 TIMERENEWAL and the permit shall expire should I not receive a
passing inspection durin an�Shx onth period during the renewal period.
— . - --- --Justification-
OWNERBLDR OR CO RACTOR SIGNATURE DA E
Print Name
STATE OF FLORIDA
COUNTY OF 2t,
ACKNOWLEDGED BEFOREsTHIS T DAY OF /(JGt/P� ,20
I`b. I
BY b" WHO IS PERSONALLY KNOWN TO ME YG� OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
, 4 OR
(40 Commission#FF zI
0
sa
SIGNATURE OF NOTAR SEAL %,. Expires June 3 201-
All
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