HomeMy WebLinkAboutPermit Renewal 04/02/2018 19:37 17723341078 PAGE 03/03
PLANNING AND DEVELOPAIENT SERVICES DEPARTMENT
BUILDING AND CODE REGUL,ATIQNS DIVISION
2300 VXRGIINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772) RECEIVED
PERMIT RENEWAL R ,QUI,%T R 0 5 2018
ST. Lucie County, Permitting
PERMIT NUMBER.: I-1D-1^ a :� Z_ ADDRESS: 11606 - OC-51[11) Iq �1
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 QNE TIME RENEWAL and the permit shall expire should i not receive a
passing inspection during any six.Month period during the renewal period.
Justification
0 ER! DR OR CONTRA[ OR SIG. ATURE DATE
Print Name
STATE OF FI ORII)A
COUNTY OF
ACKNOWLEDGED BEPORyB MG 771IS DAY OF
13Y �/ r'/�G/ . ., WHO 15 J'J:KSONALLY KNOWN TO ME_._ —�OR
HAS PROVIDED ��� AS IDEN'T'IFICATION.
�SIGNATU
T 'OF FLORID my ' _ �%E_xplres=3/2010
�esine Ann Waininan
NOTARYPUBLIC
TAlt of FLORIDA
A T F1=145434
FOR OFFICE USE ONLY: r• r.:. ......
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of.opcn inspactions)
Percentage_ _
Original permit fee: x%open = $ __Renewal fee
Example: (15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal tee)
Revised 7/21/2014