HomeMy WebLinkAboutPermit Renewals -�.�=I 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 2 6 2:020
PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: 1 ADDRESS: 1 1 Vv
1, DC ,am requesting th t thWaoV(6�pemit be renewed. I
and a id t ami t I must sc eclule 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 inspectiq during ny six i th period during the renewal period.
Justification
6k�6
OWNER/BhDR OR CONTRACTOR SIGNATURE DATE
Print ame
STATE OF FLORIDA
COUNTY OF S�
ACKNOWLEDGED BEFORE ME THIS ado DAY OF 20 as
BY 5 qS WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L L`I AS IDENTIFICATION.
STATE OF FLORIDA,County of
OEANNAMARIRIEG!VENS
MY COMMISSION#GG 022023
t
EXPIRES:December 16,2020
SIGNATURE OF NOT ��o BondedTh6! !RrYPublicUiderwriters
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