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
RECEIVED
PERMIT RENEWAL REQUEST JAN 0 7 2019
ST. Lucie county,Permitting
PERMIT NUMBER: 'Z C7 ADDRESS:
k-�.y, 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 v S e, P Q.P vlw 1
WMBLDIC—OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLOWk LUC E
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _DAY OF, JA Cj .20
BY J a�n►.1 WHO IS PERSONALLY KNOWN TOME ✓ OR
HAS PROVIDED AS IDENTIFICATION.
STATE O FLO ounty oj)GAL
�+�' KAREN S. NIELSEN
o��`Y" :State of Florida-Notary Public
SIGNATUREO NOT S _. *= Commission# GG 207484
My Commission Expires
June 12, 2022
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