HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
RECEIVED
APR 29 2019 PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: /��S 0u y 3 ADDRESS: 3 2 3 7 f?-
I,
I, L- ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finale,d. 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 W C- to s i �P7z,�r T ,4� wore/� u�j losv�z j C->7
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLO D
COUNTY OF
AC OWLEDGED BEFORE ME THIS _DAY OF 20-
BY I�� ��N��WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF ORI County f
KAREN S. NI$jS�EN
AG A OF N AR ,`, Y°°B', A
� ��;State of FloridaIVo ry ublic
'* �= Commission #GG 207484
a' M Commission Expires
' %�`OF f�O� y P
mnoJune 12 7022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%o open = $ Renewal fee
Example: [15 divided by 23,=.65(%)1 $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014