HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS 1 Mg% C��p
2300 VIRGINIA AVE
FORT PIERCE, FL34982
(772) 462-1553 Fax (7U) 462-1578 5 E P 2 6 L' 18
LST. Lucie County, Permitting
PERMIT RENEWAL REQUEST
PERMIT NUMBER: / '7 0 / — O / iJ. ADDRESS: S P / Z P, ,,, e -/r f r
I, t� o2a T _5`. S.o, , am requesting that the above permit be renewed. I
understand that I ust sched le and pass all required inspections for the permit to be frnaled. 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 oyi i S s c
OWNS L 0$ O CT SIGNATURE DATE
� O 0 %Li i 5; �n /JS m-,
Print Name
STATE OF FLORIDA
COUNTY OF ,(,,
ACKNOWLEDGED BEFORE ME THIS ar° DAY OF <a 6 20
BY'P O \ V y S'\m �5 O"^ WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED O �► A8 IDENTIFICATION.
OF FLORIDA, Count7Lof !g-
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
EXPIRES: My COMMISSION
20203 II{
Example: [15 divided by 23=.65("/u)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 721l1014
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 ----
(772) 462-1553 Fa, (772) 462-1578
PERMIT RENEWAL REQUEST MAR U 8 2020
ST. Lucie County, Permitting
PERMIT NUMBER: I70I—n14a- ADDRESS: `J31z Ae,,�/N2-DriyP-19tt"Tf'2a?t -Kc
I, 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 " 1tfsl �Iou!'° {tom UV2�� r d weir-
O LR/B DR ORCONTRACTOR SIGNATURE
Pnnt Name
STATE OF FLORIDA
COUNTYOF
ACKNOWLEDGED BEFORE ME THIS DAY OF
/dn�o
DATE
20 as
By \y-4% m> cat C'*" a 4\ WHO IS PERSONALLY KNOWN TO ME . OR
HAS PROVIDED f L. O L AS IDENTIFICATION.
OF FLORIDA,
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
DEANNA MARIE GIVENS
MY COMMISSION # GG 022023
EXPIRES: December 16, 2020
Bonded ThANDry public Undenvdter
Example: [15 divided by 23=.65(%)] $175(pennit fee) x .65=$113.75 (renewal fee)
Revised 7/212014