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: '�/ VADDRESS: 70 v
am requesting that the above p it 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
OWNS LDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA ll
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OPERSONT
20
BY WHO IS KNOWN TO OR
HAS PROVIDED AS IDENTIFICATION.
t
STATE OF FLORIDA, my o s*,Zz
fA)d Y),I/VA 95� �5&
SIt;WATCTiW61U
OTARY SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections: YsiY'ei'•., AUDREYB.HUMPHREY
Total Inspections: �-_ MY COMMISSION#FF 174772
(Divide open by total to get%of open inspections) EXPIRES:March s,lois
Percentage: Bonded Thru Notary Public Underwriters
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
RECEIVEDRevised 7/21/2014
JAN 242019
Permitting Department
St. Lucie County, FL