HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
s BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-15.
RECEIVED
PERMIT RENEWAL REQ1 JEST N 0 V 2 2 2019
7 f �° ST. Lucie County, Permitting
PERMI�'NUMBER: /�06-0416 ADDRESS: cy qe3 &&A mi, a
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
passing inspection during any six month period during the renewal period.
Justification Fae Q -to 1&44
��2
O RIBLDR OR CONTRACTOR SIGNATURE bATE
Print Name
STATE OF FLRI�A�— — --
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS Z2 DAX OF� 111'k .l .2019
BY 1t�'� },d, NPU- WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STAR,OF FLORIDA,County of 75ne f Aa
P �#VN Notary Public State of Florida
Lisa A Stevenson
v� My Commission GG 212244
TURE OF NOTARY gg '�a Expires 08!24!2080
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
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Example: [15 divided by 23=.65(%)] S175(permit fee)x.654113.75(renewal fee)
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Revised 7/2112014