HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
� P BUILDING AND CODE REGULATIONS DI SION`ZECEIVED
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 MAR 0 3 2020
(772)462-1553 Fax(772)462-1578
ST. Lucie County, Permitting
PERMIT RENEWAL REQUEST
PERMIT NUMBER: ���1-d�yl ADDRESS: GA) GanA�2
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 gqduring any six month period during the renewal period.
Justification tN 6r �Pwa v 0�I r—0 0!),S `t- C= u LSg 744p— WOYZ 1C
I
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Prfnt Name
STATE OF FLORIDA
COUNTY OF-.V %--"I`
ACKNOWLEDGED BEFORE ME THIS DAY OF 2�>
d
BY fl� s J t C�s"}d\�6 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L D L AS IDENTIFICATION.
STATE OF FLORIDA,Coun of S • �- ��� � ,,, a ��m :a 'g-:�.
;.�o••- DEANNA MARIE GIVENS -;
MY COMMISSION#GG 02202
SIGNATURE OF NOTARY qua EXPIRES:December.6,2020
}Fo�F;4lxAonded 7hru Notary Public Witt- tilers
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