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HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT e - BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE RECEIVED FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 APR 29 2019 PERMIT RENEWAL REQUEST ST. Lucie County, Permitting PERMIT NUMBER: OSZ ADDRESS: I gfy ;9pD7� I, O&VU-Z2 V Z ,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 atz-,ay 2 f'7 .t,0 F!,*-7- _ lee"e-9)47- 0 -9f%O R/BLDR OR CONTRACTOR SIGNATURE DATE Print Name STATE OF FLO A 1 COUNTY OF ACKNOWLEDGED BEFORE /SME TMSDAY OF 20 BY P,Y 1 1 I U Imo©2— WHO IS PERSONALLY KNOWN TO ME OR HAS PROVIDED AS IDENTIFICATION. STATE OF LORI A, ount of , KAREN S. NIELSEN =o`er ,Stat & e of Florida Notary Public S GN RE 0 O Y S .- Commission #GG 207464 My.Commission Expires %fxoFe�oO June12, 2022 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 �� 166 3