HomeMy WebLinkAboutPermit Renewals --tt PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
L ; , , 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST DEC 17 2019
ST. Lucie County, Permitting
PERMIT NUMBER: IC10 ADDRESS: 20(p
I, M I�[hAE L 4n io E ,am requesting that the above permit be renewed. I
understand that I nitist1s6hedule 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 montl>,period durin the renewal period.
Justification C-16
OWNERIBLDt OR CONTRACTOR SIGNATURE DATE
midaAEL
Print Name
STATE OF FLOR rr
COUNTY OF l
ACKNOWLEDGED BEFORE ME THIS 1—DAY OF le-C 20 19
BY on,
l( �A ®p WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED T�L AS IDENTIFICATION.
STATE OF FLORID unty
"" KAREN S. NIELSEN
SIGNATURE OF NOTA ;:° State of Florida-�` EAgy Public
Commission # GG 207484
My Commission Expires
June 12 202.2
FOR OFFICE USE ONLV:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ 16; _Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014