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
JUN 2 ?10i9
Permitting Depart
PERMIT RENEWAL REQUEST St. Lucie Countyenr
PERMIT NUMBER V �/L0" ADDRESS: uG� I O ^} ck%0
I ; S 6�\\k CCI\. am requesting that the above permit be renewed. I
un erstand 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 e"�
O ER/BLDR OR CONTRACT&I SIGNATURE DATE
kL 1 C-04
Print Name 14 M
STATE OF FLORIDA f
COUNTY OF
ACKNOWLEDGED'BEFORE M �
E THIS _DAY OF ��Nt;� ,20
BY \C0-Qa% ' C) WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED ( - D AS IDENTIFICATION.
STATE OF FLORIDA,County of 1�i.(;(I-e-
Flr<� ��� �� ELLENVAUGHN
SIGNATURE OF NOTARY =�� State of Florida-Notary Public
=' *_ Commission # GG 270079
My Commission Expires
------------------------—------------—----------—------—----------------------- ---------
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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