HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
J - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
RECEIVE®
PERMIT RENEWAL REQUEST OCT 3 "0 1 9
J ST, Lucie County, Permitting
PERMIT NUMBER: U 0 ADDRESS: � � fV4 c)r haq e
I, r Iur<°y ( c r 6-6f4"410&- ,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 L'l-oec z�w e,,
OWNERBLDR OR�CONTRACTOR SIGNATURE DAYE
Print Name
STATE OF FLORIDA
COUNTY OF 6k. �–�c��� d
ACKNOWLEDGED BEFORE ME THIS�—DAY OF d GA 20� 1
BY V-,h-L--h F 4 1',C,16 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �t �. AS IDENTIFICATION.
STATE OF FLORIDA,County of S 3r• `'U� e ., DEANNA MARIE G1 S�
f ti.•• my COMMISSION#GG 0-20c3
EXPIRES:December 16,2020
SIGNATURE OF NOTARY �o, � Bonded Thru Notary Public Underwrite s I
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