HomeMy WebLinkAboutPermit Renewals 08/07/2019 WED 12: 01 FAX 772 877 2735 White Aluminum - PSL 0001/001
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2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 A Li G 02019
�T, lrucle County, Permitting
PERMIT RENEWAL REQUEST
PERMIT NUMBER: I`1 ���/ ADDRESS: 9U17— 'effAcWt
I, (-ayl LaRcLe"I ,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. n,p
Justification KD ( i&) il�(lY\..t (+i&U-t
LAJ)W fL' U11 klby'n-P 4 kat. CALLCC. e t I OV-1
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OWNER/BLDR OR CONTRACTOR SIGNATURE OATA
145atl( �cc/lG l
Print Name
STATE OF FTtCOUNTY01
ACKNOWLEDGED BEFORE ME S DAY OF . .20
BY _ L WHO IS PERSONALLY KNOWN TO OR
HAS PROVIDED AS IDENTIFICATION.
UTOjFL 0 DA, f �� NotaryPuW Stato of FWtd6a•Angela Staples
F NOTARY s Eipim 071 22 COMMIUW GO 235th
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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