HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
LAMAS Wz - 2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
JAN 0 7 2019
PERMIT RENEWAL REQUEST
ST. Lucie County, permitting
PERMIT NUMBER: ADDRESS: .
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 C
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LDR OR CONTRACTOR SIGNATURE D— ATP
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Print Name
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STATE OF FLO
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COUNTY OF Q
ACKNOWLEDGED B.)FORE ME THIS _DAY OF C f f� ,20
BY i i� Y non WHO IS PERSONALLY KNOWN TO ME_ OR
HAS PROVIDED AS IDENTIFICATION.
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STATE 7 FLO A,Coun of
\' KAREN S. NIELSEN
Fallon Public
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S �=c ,State of Florida Nota207A84
SIGNATURE OF NOTARY .= Commission# GG
-' My Commission Expires
OFF�OF\ June 12, 2022
III IFFF
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 7121/2014