HomeMy WebLinkAboutPermit Renewal i
_ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION RECEIVED
2300 VIRGINIA AVE MAR 0,2FORT PIERCE,FL 34982 ZOZo
(772)462-1553 Fax(772)462-1578
PermlttOo 9ePartment
St.Lucie Cpegty
PERMIT RENEWAL REQUEST
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PERMIT NUMBERI ADDRESS:
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i, 'V-, ,�, t ���} � ,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,'II
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. Q
Justification "D1 � n-� �/—V'aw —�kQ
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O L OR CONTRACTOR SIGNATURE DATE
rin Name
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STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF (� 20_0
BY � 0 Ul' WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED I2C. AS IDENTIFICATION.
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STATE OF FLO WDA,County of S l
`icy pVe� ELLEN VAUGHN
W-F5V`
State of Florida-Notary; Public
SIGNATURE OF OTARY SEAL ^ = Commission #GG 270079
'ofF� My Commission Expires
prnn�` October 22, 2022
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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
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