HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT'SERVICES DEPART1VIEi\1'�
In ' BUXLDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PXERCE,FL 34982
(772)462-1553 FaX(772)462-1578
RECEIVED
PERMIT'RENEWAL REQUEST
MAY 2 8 2020
ST.,Lucie County, Permitting
PERMIT NUNMER:� ^' ADDRESS: '
I, $ a ��,-UAAS am requestinng that the above permit be renewed. I
understand that must schedule and pass all required inspections for the pgrmi 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 duxinng any six month period during the renewal period.
Justification '
° CIrpt e �ISO ,
fL nen
OWNER/BLDR CUR CUR ONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLQWA ,
COUNTY OF Ir
ACKNOWLEDGED BFFO10✓ME THIS DAY OF
EX . WHO IS PkRSONALL KNOWN TO MEJI ,OR
HAS PROVIDED AS IDENTIFICATION.
12AT'TE 0 F A,County of J
f +r*Y° Notary Public State or Noma
Ashley M Anioneili
` 4 My co—nission GG 152970
N 1 O1 NO V S '�uvn Expires 1q/1812t721
FOR OMCE USE ONLY:
Number of Open Inspections:
Total'Inspections:
(Divide open by total to get%of open inspections)
PeF6eptage:
OrigbW permit fte: x%opeu = $ Renewal fee
Exainplc: 115 divided by 23=.65(0/o)) $175(pelnlit fee)x.65=$113.75(renewal fee)
Revikd 7121!2014