HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND'CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
-- - ---- ----- FORT PIERCE, FL 34982
R F(-FTVFI) (772) 462-1553 Fax (772) 462-1578
APR 0 5 2018 I PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: V 6-1- Oii , a _ ADDRESS: �2I T (� 5- Kam(
I, GGt ✓;,c Aro4C., 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
�WNERBLDR OR CONTRACTORSIGNATURE
Print Name
DATE
STATE OF FLOVI
COUNTY OF �
ACKNOWLEDGED BEFORE ME THIS _DAY OF 20-
BY &Z, C A i`if-J1- WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED • L• . AS IDENTIFICATION.
STATE
I(AREN S. NIELSEN
Commission # PFAU 5637
My Commission Expires
June 12. 2018
FOR OFFICE USE ONLY:
Number of Open Ins ons: \ 5
Total Inspections: T—
(Divide open by total to get % of open inspections)
Percentage: - q23
Original permit fee: \0960 .06 x % open = $ �61 SO Renewal fee
Example: [15 divided by 23=.65("/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014