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 RENEWAL REQUEST JUL:0 9 2019
ST. Lucie county, Permitting
PERMIT NUMBER: 11007"0828 ADDRESS: 4795 Jorgensen Road
I, L4 JJ-- ,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.
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Justification ' U� VOM4 4 t it'. p�
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OWN T ACTOR SIGNATURE E
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Print Name
STATE OF FLOA _ ,
COUNTY OF _ L i t C(
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ACKNOWLEDGED BEFORE ME THIS � DAY OF �/L1 ,2019
BY Larf c QST., ` O IS PERSONALLY KNOWN TO ME 1/� ,OR
HAS PROVIDED AS IDENTIFICATION.
STA F FLORIDA,County of St Lucie
W'NN'V'J�IV�
SIGNATUR F NO ARY ys� e�tete of Florida
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my Commission GG 241&45
Expires 07!25!2022
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 7121/2414