HomeMy WebLinkAboutPermit RenewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300VIRGESIUAVE _
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-15781"' M,: ��
PERMTRENEWALREOUhST JUN 1 9 2020
ST. Lucie
PERMIT NUMBER: + (75 — b b o ADDRESS: 4;-00 IV, Nil F1 waq A!M
olvreS ��rioreS , 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 inspectio wring any six month 1period during the renewal period.
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Justification dQi'-e
(). NERBLDR'm CONTRACTOR SIGNATURE
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Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS = DAY OF
BY
HAS PROVIDED
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ATE
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KNOWN TO ME1 .OR
AS
STA OF FLO A, Coun o",'••
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MY COMMISSION 8GG069099
EXPIRES: Apd12.2021
SIGNATURE OF NOTARY " 9omeaTnm Nolan Public UndarAlm
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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(Y,)] $175(petmit fee) x .65=$113.75 (renewal fee)
Revised 7n1f2014
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