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: / U 'V /� ADDRESS: Alk-yil)f7 A✓+Q,
11 r, /el140 RIO S ,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 n%0_,,r- L06k-c-,) U yj c_%y-o-k 1 cl�
r /
OWNER/13R CTRACTOR SIGNATURE DATE
Print Name
STATE OF FLO. .
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF / I 20H-1
BY GI ! , P r fV O S, WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
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UDR�YB.SIGNATURE O OTARY SE '�B�".2023--------------------------------------------------------------------------------
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
It" ECEIVED
MAR 19 2019
Permitting Department
St. Lucie County, FL
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