HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
s 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
B05PERIMITNUMi3ER: ?� — ~ ADDRESS: I �� J
I, �mr\a LLQ ,aril 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 ( k(N CA I U013J�VfCJ
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
3hatontiy, LK�eS
Print Name
STATE OF FL DA
COUNTY OF �
ACKNOWLEDGED BEFORE ME THIS DAY OFffb-q-
20_Lq_
By �� _WHO IS PERSONALVY KNOWN TO ME ,OR
HAS PROVIDED __ AS IDENTIFICATION.
STATE OF FLORIDA,County of age
ic State of t=tafida
• ntonelli
I I I V\(,\ qsion GG 152970
IGNA U OF T Y SEAL 18;Z021
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 = S Renewal fee
Example: [15 divided by 23=.65(%)] S175(permit fee)x.65=$113.75(renewal fee)
Revised 7;2112014 potg
MAY 28 2Ji9
Permitting L)epartrnent
St. Lucie County, FL