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)462-1578 R-ECCIVED
PERMIT RENEWAL REQUEST JUN 2 7 2019
ST. Lucie County, Permitting
PERMIT NUMBER: �— 1 ADDRESS: S g�g 60e'4 C!7 CR
I, L(4:,d bi, l'Q ,am requesting that the above permit be renewed. I
understand that I must sch dule 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 inspect' n during any six month period during the ren wal period.
Justification es a� e 13ee 6-4 A l h F 7
l.�
6/Z ?Ilq
7' OR,CONTRACTOR SIGNATURE DATE
r nt Name
STATE OF FLO A
COUNTY OF
WLEDGED BEFORE MEHI
TS � DAY OF 20�
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE FLORID, Coun of
SIGNA—rURE OF TARP L-4
��, KAREN S. NIELSEkh
"
BState of Florida-Notary PublicCommission #GG 207484----- aacMy Commission Expires
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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(%)] $175(permit flee)x.65=$113.75 (renewal fee)
Revised 7/21/2014