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
PERMIT NUMBER: ( 9 — ./ADDRESS:
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
(I passing inspection during any six month period during the renewal period.
Justification
OWNERBLDR OR CONTRACTOR SIG ATURE DATE
lJ a rs
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS V DAY OF
BY C �e V f 1 WHOISPERS, $14kLY KNOWN TO ME OR
HAS PROVIDED II W1 V AS IDENTIFICATION.
STAT FLORIDA,CouqW.of
;•t,p'r',vU AUDREY B.HUMPHREY
SIGKA'ftW OF N ARY SEA tii: �P#: MY COMMISSION 9 GG:00817
u. {�gy��. , �= EXPIRES:March 6,2023
Bonded Thru Notary Public Undenrrriterss
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 RECE,,"
VEtD
OCT 102019
Permitting Department
St. Lucie County, FL