HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
BUILDING AND CODE REGULATIONS DIVISION
. , 2300 VIRGINIA AVE RECEIVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
FEB 2
PERMIT RENEWAL REQUEST I ST. Lucie County, permitting
PERMIT NUBER: U J V ADDRESS: (�
MvV U C ( 1 V
I, r , am requesting that the a ove permit be renewed. I
understand that I must sc e u e 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 inspecticAn during any six month eriodduring the renewal period.
Justification I'lIn49A 120 A i
O LDR O ONTRACTOR SIGNATURE DATE
e1
dc�
Pnnt Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS -3�; DAY OF 120 'k(3
BY Ly°`� ��5 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED ��' O`' AS IDENTIFICATION.
STATE OF FLORIDA,County of
DEhNNA MARIE GIVENS
E* Y COM1J1SSION#GG 022023
SIGNATURE OF NOT Y 9} `0 SEW
IRES:December 16,2020
'•.Fo`FCo.
P.° Bonded
76N Notary Public Undenvrite.•,3 f
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