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PLANNING AND DYVELOPMENT'SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION •
,• 2300 VIRGINIA AVE
' FORT PAERCE,FL 34982 RECEIVED
(772)462-15$3 Fax(772)462^157
1.: OCT 0 9 2019
PERMIT RENEWAL REQVAT
I,uclo County, Per
PERMIT NUMBER: ADDRESS: hey
amrequesti�ig that the above permit be renewed. I
understand that I must schedule and pass all required Inspections for the permit to be finaled. Fuithelr,I
understand that this is a ONE TIME RE VYAL and the permit shall expire should I not receive a
a' passing inspection during any six month period during the renewal period.
Justification^ Q
O DP,DRCONTRACTOR SIGNATLTn DATE �
)?z;itlr Name
STATE OF FIA 1 �,
COUNTY OF
ACKNOWLEDGED BEFORE W'PHIS DAY OF� D ,2U
,• rP°
BY (`! V et C WHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED _ (� C �r�CPl1 i� _ AS IDENTIFICATION.
STATE kNTA7r'
County of M
.� CHERYL GEORGES
rt Coll M!ss1011#$G 34766]
SIGNATURE �p &Mks Match 4,2023
• �aPFb� 6ohded7Tu4BuEaatNo�erySarrl�a
FOR OFFICE USE ONLY: T ----
Number of open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Zxample: [15 divided by 23—,65(%)1 $175(pe:rmit Fcc)x.65=$113.75(renewal fee)
Revised 7/21/2014