HomeMy WebLinkAboutPermit Renewals s
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
L41• M!*
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 REC
PERMIT RENEWAL REQUEST DEC 012 201179
ST. Lucie County, Permitting
PERMIT NUMBER:
SLC1903 0025 ADDRESS: 1292 Nettles Blvd -
I,Dc) PL G m.c ,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.
ltification�Dry-\p ,E, A I�!
Ce, 1 S SC S �4 e—d fl
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
eckChe.
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS a�° DAY OF 1 ,20 Ct1
BY ��` C-����� WHO IS PERSONALLY KNOWN TOME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
KIMBERLY MARIE CASA
SI ATURE OF NOTARY SEAL ;•cA.*P
MY COMMISSION#GG 205T63
: EXPIRES:April 10,2022
•Fod(°'' Bondo Thru Notary Putt Underwriters
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(0/o)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014