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
PERMIT RENEWAL REQUEST
ERMITNUMBER / 3 2 ADDRESS:
G 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.
Justification
O EP9LDR OR CONTRACTOR SIGNATURE DATE
�4
Print Name
STATE OF FLORPL-_
COUNTY OT �f 4,,-
ACKNOWLEDGED
vACKNOWLEDGED BEFORE ME THIS DAY OF 120 l
BY 1'."A, WHO Is PERSON LY KNOWN TO OR
HASTROVIDED AS IDENTIFICATION.
STATE OF FLORIDA.Counh_,e€ ciz i
•,►o*-' WILLIAM H DONOVAN JR
SIGNATURE OF NOTA MY COMMISSION*GG043576
EXPIRES April 12.2021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspeczions:
(Divide open by total to get%of open inspecnow,
Percentage:
Orieinal Dermit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)1 $175(permit fee)x.65=$113.75(renewal fee) E C. E I V E D
Revised 721/2014
AUG 2 9 2019
Permitting Department
St. Lucie County, FL
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