HomeMy WebLinkAboutInspection Docs PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RECEIVED
u" FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
SEP 13 2019
PERMIT RENEWAL REQUES1 ST. Lucie County, Permitting
PERMI BER: ADDRESS:
am requesting t at 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
OWNERJBL6k dR CONTRACTOR SIGNATURE DATE
z
Print Name
STATE OF FLO 1— t
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF fl11,9 71VI ,20
BY�OWL 1r7 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED- b L. AS IDENTIFICATION.
STATE F FLORID!, ounty
SIGNATURE OF NOT ;1pPY PUg REN S. N I E
=o � State of Florida-NotarrS E N
y Public EAL
Commission # GG 207484
My Commission Expires
June 12, 2022
.11
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage: QQ
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