HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
r 2300 VIRGINIA AVE RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
SEP 232019
PERMIT RENEWAL REQUEST ST. Lucie County, Permitting
PERMIT NUMBER: 6 UJB. 11OL1-O 31ADDRESS: y �3 �7 SCO { E// ��• /"/C(C� r ����Z
I, all"611 Z�o freel,✓10V JP 2 ,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.
Justifications �Yl �7�IS/lP��ir� • c9/� ��f p�/` /O
OWNE LDR O T CTOR SIGNATURE DATE
Print Name
STATE OF FLORI
COUNTY OF (j
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY ® �'Z,WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
r
STATE OF F%ORI ountyof •/
KAREN S. NIELSEN
State
SIGNATURE OF NOTARY =•� �� Commission# GGa29_A84c
My Commission Expires
June 12, 2022
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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