HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
JUN 26 2019
PERMIT RENEWAL REQUEST
ST, I_ucie County, Permitting
PERMIT NUMBER: 5\Q)- r oZaq ADDRESS: 016: )GadCP
1, A11
�5 ,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 6-LMTl—
I /
OWNtMEbV0V-CONT1kACTOR SIGNATURE DATE
Yu iUayl
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Print Na e
STATE OF FLORIDA
COUNTY OF SN .
ACKNOWLEDGED BEFORE ME THIS DAY OF J V Y\� 20 _
BY "W?'X u� '.-) WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �L ``L AS IDENTIFICATION.
STATE OF FLORIDA,County of
A� P.;�, DEANNAMARIEGIV[N5 4
°= MY coMMIS510N;P GG 022023
S ATURE OF NOT Ya ExggkE.Doeambor 1S,2020 .
eoFF�oQ•` Bonded Thru Notary Public Und—rits
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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(%o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014