HomeMy WebLinkAboutExtension request, 6 month RECEIVED
\ \t- 00g s' • MAR 26 2018
Re Permitting Department
RECEIVED St. Lucie County
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_ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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— — FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1Z.10 -00 g ADDRESS: 58 6 c'Jl% ACg Atf F f t id c. ,i 4, �L
I, r e r br Ne,..nn of ,am requesting that the above permit be renewed. I
understand that I fnust 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 .Jo f V
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OWNER/BLDWOR CONTRALTO SIGNATURE ATE
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Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF ,20
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
SIGNATURE OF NOTARY SEAL
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