HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
FEB 0 7 2020
PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: 'O 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 inspectio during any six month period during the renewal period.
Justification e
cin r^
OWNER/BLDR OR CIDNTRACTOR SIGNATURE DATE
L i n6, LP-,Y,-r
Print Name
STATE OF FLO I A
COUNTY OF
ACKNOWLEDGED BEFO ME THIS DAY OF � ,200
BY ?—A{� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS.IDENTIFICATION.
STATE OF FL RIDA,C u ty of
SIGNATURE OF NOTAR = PUAfIELEN
,!' Staite of F or da AREN S.Nf§EtALS Public '
=* •� Commission"#GG 207484
i9� oa° My Commission Expires
June 12, 2022
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 = $_-7�Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014