HomeMy WebLinkAboutPermit Renewals • (7
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
�f BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST JAN o 7 2019
ST. Lucie County, permitting
PERMITNUMBER:b ���_`��Z�' ADDRESS:R adE De hQ"'4 Qu Q-
1, �:_Aa4n.�. Ca�`^-�'�-' ,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(s�ix month period during the renewal period.
Justification �'' — `i� e,r
�c-T1 ��
O` R/BLD OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLOP ] A
COUNTY OF
La I
ACKNOWLEDGE ,EFORE ME THIS DAY OF �Ra-
,20 IR
BY c_�la WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF LORIDountyof
, KAREN S• NIELSEN
;=oa��;Stata of Florida-Notary public
(1 Aj AASI SEAL SIGNATURE OF T •= Commission # GG 207484
z�
My Commissi 2022Pires
`O
ll°iin``� June 12,
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