HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RC>;XV
- FORT PIERCE,FL 34982 ED
(772)462-1553 Fax(772)462-1578
JUN 2 7 1019
Permitting Dr,
PERMIT RENEWAL REQUEST St.Lucie County ens
PERMIT NUMBER ~( Vy" ADDRESS: (aq O ck 1
I,AS C 'W�� C� \�" am requesting that the above permit be renewed. I
understand that I must schedu a 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 �;,.� c
9
OWNERABLDR OR CONTRACT SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF J0VO 20—d-
BY ��\C h��S1 C�aQ WHO IS PERSONALLY KNOWN TO ME_ ,OR
HAS PROVIDED (_ D AS IDENTIFICATION.
STATE OF FLORIDA,County of
F1 Iri i \sELLEN VAUGHN
SIGNATURE OF NOTARY o,State of Florida-Notary Public
Commission #GG 270079
?ofno°°: My 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 fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014
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