HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ( 7(/ / ` 0-:� O-/ ADDRESS: /31 ��y D2 0 JC '
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//I )• (` c� 1 �j
OWNER/B DR OR CONTRACTOR SIGNATURE DATE
Rad
Print Name
STATE OF FLORIDA
COUNTY OF a v�
ACKNOWLEDGED BEFORE ME THIS c Pq DAY OF G 20
BY,,J& Y-) WHO ISP 0 L CNOWN TO M
OR
HAS PROVIDED AS IDENTIFICATION.
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STATE 0 FLORIDA,County of
SIGNATURE F NOT Y SEAL
FOR OFFICE USE ONLY: .ro'�"°ya��, AUDREYB.HUMPHREY
„c *= MY COMMISSION#FF 174772
Number of Open Inspections: -,�•� EXPIRES;March 6,2019
Total Inspections:
P,,,,,,,,•` Bonded Th,Notary public Underwriters
(Divide open by total to get%of open inspections) t
Percentage:
Original permit fee: x%open = $ Renewal fee RELCEIVED
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fe )
Revised 7/21/2014 JAN 2 4 2019
Permitting Department _
St. Lucie County, FL