HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
UNiy BUILDING AND-CODE REGULATIONS DIVISION
* 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVE®
PERNHT RENEWAL REQUE T L l 0 6 2019
ST. Lucie County, Permitting
PERMIT NUMBER: 9 0 1 — 06 I ADDRESS: 5 b ) 3 0 oAM" A vi- ke C 1 (c"/
I, a / C Ag P / C( q ,am requesting that the above permit be renewed. I
understand that I must schedule and p ss 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 mon h period during/the renewal period. j A
Justification U CJ rye- �v �� 1 �ja� C 2 l/ -�'�✓ N 1 /7J✓��c /'I v✓p
5
OWNER/BLDR OR CO TRACTOR SIGNATURE DA E
Print Name
STATE OF
FLOR
F
COUNTY OF 1
ACKNOWLEDGED BEFORE ME THIS ( n DAY OF 20
BY �f, t=1 J 6fV "` WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED 1 `/ AS IDENTIFICATION.
STATE 0 LO A,Coun f (�41�—C Jl 1
SI NATURE'OF NOTARY KAREN S..NIELSEN
-state of Flbrida-Notary Public
=* Commission #GG 207484
MY Commission Expires
------------------ -------------- --lµfr+�L--------_-duAe 12_2 42�----- ------------------------------------=
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