HomeMy WebLinkAboutPermit Renewals May, 28, 2020 10:58AM No, 0237 P. 1
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND,CODE REGULATIONS DIVISION
7300 VYYZGYNYA AVE RECEIVED
FORT PIERCE,FL 349$2
(772)462-1553 Fax(772)462-1578
MAY 2 8 2020
PERMIT RENEWAL REQUEST Si• Lucie County, permitting
PERMIT NL)MBER:17aY dOo?,? ADDRESS:lYTOS—,414l �4YCdJod��4C�
I ' x to requesting that the above permit be renewed. I
understand that I titst 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.
0.
Justification _/l/� A/ ,�' eelf) .O&-. %e- /d cf eZ.
OWNER19LDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA ,
COUNTY 0P
ACKNOWLEDGED BEFORE ME THIS aCQDAY OF y4W2/ ,20
BY, f � T , r2�WHO T5 PERSONALLY KNOWN TO ME��OR
HAS PROVIDED AS IDENTIFICATION.
STATI? RIDA.County of r
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MY C0MM1831bN t�(�93ZA78
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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(%)] 5175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014