HomeMy WebLinkAboutPermit Renewals Off PLANNING;ANWI)EVELOPMEINT SERVICES DEPARTMENT
F � BUILDING AND CODE REGULATIOlNS DIVISION
2300:VIRGV4U AVE
FORT PIERCE,FL 34081 RLCEIVE-D
(77M)462-1553 Fax(772).462-1578
AUG 2 5 2020
PERMIT RENEWAL.REQUEST , Lucie County, Permitting
PERMIT NUMBER: ADDRESS:.t51 t9 �'U 'r n D( ,
arequesting m: that the above permit be renewed. I
understadd,that1i'U9f schedule and pass all required inspections for the permit to be finaled. Further;I
understand that ME°this is,a ONE TI RENEWAL and the permit shall expire should I not receive,a
passing inspection during.any six month period during the renewal period.,
Justification-- -fit pr t uf—er Luis ouA aE ic,.yx
OWNE�R.OR CON4VACTOR SIGNATURE DATE
�L
PrintNaime
STATE OF FLOD ;
COUNTY OFLM
a
ACK.'�10WLEDGED:BEFppO��RE ME THIS: DAY OF ;.20
13Y t / .WFIO IS PERSONALLY KNOWN TO ME OR.
HAS PROM D. AS.IDENTIFICATION.
STATE OF FLORIDA,Countyof
s g0� Notary Public$tatQ.of Florida
SIGNATURE OF NOTARY SEA; ' Amanda P:Sandecson.
e; My C�mmission GG 211256
Expires 04125121M
FOR OFFICE USE ONLY.,
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original.perrriit fee:. x%open = Renewal fee.
Example: [1'5 divided by 23=.65(%)] $175(permit fee)x.65=$113.7-5(renewal fee)
Revised 712I12014