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)462-1578RECEIVE®
PERMIT RENEWAL REQUEST MAY 17 2019
ST. Lucie P-mititV,,t*-"4 1,
PERMIT NUMBER:1t 44%' 1�D ADDRESS: d 3 GOY- Cf )P—CY
i, P lie 1•• loo Xw-e- l l ,am requesting that the above permit be renewed. I
understaifd 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
O LDR OR CONTRAC •OR SIGNATURE DATE
Print Name
STATE OF FLORIDA ,
COUNTY OF mak.
ACKNOWLEDGED BEFORE ME THIS 1) DAY OF o.y 20A�%_
BY ��~$ md`k�`L`� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED 'F L b 1-- AS IDENTIFICATION.
STATE OF FLORIDA,County of • LJ C `r- DEANNAMARIE GNENS
�S..e.,�(,•I
•'� c?' MY COMR7ISSION#GG 022023
=mac EXPIRES:December 96,2020
SIGNATURE OF NOT =r o BonfiHMw Notary PUblic Undenvritecs �p
%° tom
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