HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
iCOUNTY
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
DEC 22 2019
PERMIT RENEWAL REQUES
ST. Lucie County, Permitting
d -7,4"Y
PERMIT NUMBER: ADDRESS: `� �
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 J\y t►1 cA 1 Y\
OwNff4ek OR CONTRACTOR SIGNAT ATE
Print Name
STATE OF FLORIDA
COUNTY OF S a( .L J c e
ACKNOWLEDGED BEFORE ME THIS DAY OF �'ZC 20�
BY J e�"� �y 'pl^� t (' WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,Co of DEANNA MARIE GIVENS ,
My COMMISSION#GG 022023
SIGNATURE OF N Y ;,�o lop EXPIRES:December 16.2020
B
a"ru Notary Public Underwriters, P.
�R
+r%ALS
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