HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
1 I f BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUES REC15IVED
'CT ® 9 2020
/�,I c- ST. Lucie County p
PERMIT NUMBER: /5 O ^ V TJ-1 ADDRESS: 7o �C� (L 0_ r �n9-
am requesting that the above permit be renewed. I
understand that Imust schedule and pass all required inspections for the permit to be fmaled. 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.
Justification
0Im X2 a
O R/BLDR OR CONTRACTOR SIGNATURE DIATE
Print%me
STATE OF FLO A
COUNTY OF " k
- ACKNOWLEDGED BEFORE ME THIS DAY OF 20a C
BY lei,
A 1 WHO IS PERSONALLY KNOWN TO MW ,OR
HAS PROVIDED C tC�C 1('��_ \��i(� AS IDENTIFICATION.
ST FL RIDA,County of � ��.
ppSARVq Kelly Molloy •
NOTARY PUBUG
IGNA OTARY ? 2 c STATE OF FLORIDA
- a Comm*GGrjW
soh E 19�e Expires 9/18/2022,
FOR OFFICE USE
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(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014