HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
" BUILDING AND CODE REGULATIONS DIVISION
!COUNTY 2300 VIRGINIA AVE RECEIVED
— — FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1573 APR 2 7 1018
Permitting Departmen
PERMIT RENEWAL REQUEST St. Lucie County
PERMIT NUMBER: �� —?, Y ADDRESS: rte!/
am requesting that the above permit be renewed. I
understand tha I must 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.
Justification
OWNER/j3L1j OO CONTRACTOR SIGNATURE DATE
12L L
,1,
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _DAY OF 20
BY R-� WHO IS PERSO ALLY KNOWN TO ME_ OR
AS IDENTIFICATION.
HAS PROVIDED F
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STATE F FLORIDA,( uWY of Zktj Al
;;� AUOREY S.R NPHREY 1
SI ATURE OF TARY SEAL=; � ;' AIY�W{SSh arcihf6?4 9-
EXPIRES. t
FOR OFFICE USE ONLY:
Number of Open Inspections: , f -.-
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = S Renewal fee
Example: [15 divided by 23-.65(%)] $175(permit fee)x.65-$113.75(renewal fee)
Rtvised 72112014
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