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 RECOM
PERMIT RENEWAL REQUES DEC 10 '-:!iQ
ST. Lucie-County, Permitung `
PERNIITNUNMER: 1403`O5-5C( ADDRESS: 7000— /3dLeeUr Aoe—
I, 71sia, /3o r;w ,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 Lt,ci�ai+- t✓
C: lalio // 1r
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
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Print Name
STATE OF FLO 1A
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _DAY OF20T�_
BY ISS"e1 K�' WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED L AS IDENTIFICATION.
STATE OF FLO DAA County 0
SIG A OF T """' KAREN S. NIELSE
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a° -State of Florida-Notary Public
Commission # GG 207484
_
rd MY My Commission E_x fires
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