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
RECEIVED
PERMIT RENEWAL REQUES ,JAN I
ST. Lucie County, permitting
PERMIT NUMBER: 00-7-C)2Ud ADDRESS: 5�I-7 EnsAwood ��-
I, •Q,1' fs VQ )Ne,1f5 ,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 - 9 rrn;� Was aSk
122 01A- a
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OWNER TDROR CONTRACTOR SIGNATURE AT
L�0 no-'-s' J WOL,kc,�
Print Name
STATE OF FLO DA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS S DAY OF 20 kt
BY S ck CM2 S WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L AS IDENTIFICATION.
STATE OF FLORIDA,County of
` DEp1INAGIVENS
_ PAY COMMISSIONSION#GG 02222
023
Y =�. EXPIRES:December 16,2020
SIGNATURE OF NOT
;eo�Ft�' Bonded W&4otaryPubficUndenOters
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