HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
_ BUILDING AND CODE REGULATIONS DIVISION
- 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)..462=1553� Fax(772).462-1578 iZ�-�- L U
AUG 2 5 2020
PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMITNUMBER: t9O9 - 03C:N.q' ADDRESS:_H'i � i k ti LA0i: .
am.requesting that the above permit be renewed. I
understa`d that I must schedule aridpass'all required inspections far the permit Co be fmaled. Further,I
understand that this.is-a ONE TIME RENEWAL,and,the permit shall expire should I not teceive a
assin inspection during during'n renewal period.
an .six month period ur1 the e od
P g P g Y P g P
Justification C Ic- r--=k GH -\ojd Or
OWNS !BBLLDR O�ONTRACTOR SIGNATURE DATE.
Pnrit IQ=
STATE OF FLO ,
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS^ DAY OF ,200-6
BY
I .I` t.+ .> O IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE-OF FLORIDA,County of
Notary Pubtic Stato of Florida
ou ri"Am
SIGNATURE OF NOTARY SEAL, Arn2nda P Sanderson
navy:` My C�mmtssion GG 211256
Expires 04125t2022
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get:%9 of open inspections)
Percentage:_
Original permit-fee.: x,%open = $ Renewal fee
Example: [15 divided by 23=.65(%o)) $175(pertnit fee)x.65=$l 13.75(renewal fee)
Revised W21/2014