HomeMy WebLinkAboutPermit Renewals i
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300A VIRGINIA AVE
" FORT PIERCE,.FL 34482
(772)462-1553 Fax(772)462-1578
RECEIVED
i
PERMIT RENEWAL REQUEST � AUG 2
LST.
5 2020
Lucie County, Permitting
PERI GT NUMBER: .0 l - ;3C = ADDRESS: ' ( ;
I, "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 ONK TIM .RENEWAL and the permit shall expire-'should I.not receive a
passing inspecti'on,during'any six month period during the renewal period.
Justification d I :r l
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}
-h L _
OWN�BLDR OR CONTRACTOR SIGNATURE' DATE
Print Nalne
STATE OFFLO
COUNTY OF
ACKNOWLEDGED BEFORE ME'THIS .DAY OF
BY i°t 1�1•-1 .d } 1"''7 "2: O Is PERSONALLY KNOWN TO ME OR
HAS PROV b AS IDENTIFICATION.
STATE OF FLORIDA,County of
�var Notary Public State of Florida
SIGNATURE OF NOTARY SEAL JdN,, Amanda P Sanderson
my Commission GG 2n256
�sof n Expires 0Yt2512022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original'permit fees x%open $ Renewal fee
Example: [15 divided by23=.65(%)] S 175(permit fee)x.65=$113.75(renewal fee)
Revised 7121J2014
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