HomeMy WebLinkAboutPermit renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE RE
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(772)462-1553 F (772)46 --1578
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PERMIT RENE 4HRR6Tpepartment
St. Lucie County, FL
PERMIT NUMBER: C` O 5 L r ADDRESS: Z000 b S n�aO e r n
I, L L c1. t Ir 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 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 f-e nc
io• ��, t�l
O L flIltONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF `T, -
ACKNOWLEDGED BEFORE ME THIS DAY OF U '(��• ,20-3L
BY L&K::gIQ LjLA-S-1'Z-j:-- WHO IS P TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of ('X % ' •.
91tt@M914t11DN
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SIGNATURE OF NOTARY SEAL �0fft4ia' ii�g nn 0un'dedthlrough Nation
FOR OFFICE USE ONLY:
i
Number of Open Inspections:
Total Inspections:
Divide open b total to et%of open inspections)
( P Y g P P )
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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