HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
: f r BUILDING AND CODE REGULATIONS DIVISION ,
- 2300 VIRGINIA AVE m.
"'-FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 'RECETvE(]
PERMIT RENEWAL REQUEST APR 2 6 2019
ST.Lucie County, Permitting
PERMIT NUMBER-+ �/ r Dl J ✓ ADDRESS: I 61
1, n� G4L ,am requesting that the above permit be renewed. I
understand that I must schedule and pass allx6quired inspections for the permit to be finaled. Further, I
understand`that this is a ONETIME RENEWAL and the permit shall expire should I not receive a
passing inspection duran six onth period
n durin the renewal period.
Justification n =`
OWNER/BLDR OR ONTRACTOR SIGNATURE DATE
r
nn) 5 20/-xop
Print Name` _
t >
STATE OF FIL DA
COUNTY OF [[
AC OWLEDG D BEFORE ME THIS C�b DAY OF ,20 t
By
WAIS A GLSce WHO IS PERSONALLY KNOWN TO L/ ,OR
HAS PROVIDED ,' AS IDENTIFICATION.
S AT OF FLORIDA, o ty LU
'•'' CDLEEN SULLIVAN �P'� iY;t. CbLEEW S-Lt.tLf
NATURE OF :•; v coMMISs1oN k GGa71s35 SEAL =MY co ISStO I i,t3 �rSY
r EXPIRES F®bruary 09.2021 EXPIRES Febru,Iy •4 I,;
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections: .
(Divide open by total to get%of open inspections)
Percentage` r—
Original permit fee:,--- _:_..:._: ,. �x%open � S Renewal fee
Example: • [15 divided by 23=.65(%)] $l75(permit fee)x.65=S113.75(renewal fee)
Revised 74-7 02014
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