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'-ADDRESS:
I, v ,am requesting that the above permit be renewed. I
understand thaf I must sch du and pas all required inspections for the permit to be finaled. Further, I
understand that this is a ON 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 ,
O LDR OR CONTRACTOR SIGNATURE DATE
s
Prin Name
STATE OF FLORIDA I p
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF Fe 6 '201 4
BY ,_11} 1'1 ( P 1''� WHO IS PERSONAL OWN T ME OR
HAS PROVIDED \ AS IDENTIFICATION.
STATE OF FLORIDA,County of �T' C.
SIGNATURE OF NOTJ1Y
- SEAL
FOR OFFICE USE ONLY:
� 9 eN •; AUDREY 8.HUMPHREY
Number of Open Inspections: MY COMMISSION#FF 174772
Total Inspections: I. ; .`g EXPIRES:March 6,2019
1'` ,Rf;s Bonded Thru Notary Public Underwriters
(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 RECTIVEL)
IED
FEB _ 1 2019
Permitting Department
St. Lucie COunty, FL