HomeMy WebLinkAboutPermit RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
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2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1$ 8
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: Q-10 ADDRESS: Yc/D% fa-Pelil�o
1, J0 - U 17al- , 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 during any six month period during the renewal period.
Justification
STATE OF FLORIDA
COUNTY OF Pepe 4-"
ACKNOWLEDGED BEFORE ME THIS I.RYA DAY OF / i l�r��^ ,210,2-0
BYI s!11' 2f y �• �Zz WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED AS IDENTIFICATION. f
STATE OF FLO of
r Notary Public State of Florida
Gregory F. Esposito Jr.
SIGN TUR Y SEAL My Commission GG 922224
of Expires 10/13/2023
------------------------ ----------------------------- - --------- ---------------- _— ----- _ e ._______
FOR OFFICE USE ONLY:
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Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: j
Original permit fee: x % open = $ Renewal fee
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Example: [15 divided by 23=.65(1/o)] $175(permitfee) x.65=$113.75 (renewal fee)
Revised 7/21/2014
TO: St Lucie County
RE.
Permit #
Credit Card Users: 1,5016 Surcharge added per transaction
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA �MASTERCARD
Credit Card NumberAkwma�-
Expiration. Date- - Zip Code
3 digit security code
Amount + 1.5% surcharge
Business Nan
Authorized Si
Print Name:
�
Phone: � � .�ffl
Fax:
Comments:
SLCPDSD Revised 4/01/2010 EN