HomeMy WebLinkAboutPermit Renewals J _s
PLANNING AND.DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
do 2300 VIRGINIA AVE -
FORT PIERCE,FL 34982
(772)462-1553. Fax(772)467-1578 RECEIVED
PERMIT RENEWAL REQUE T MAY 16 2018
ST. Lucie County, Permitting
PERMIT NUMBER U�- — ' ADDRESS: '\J
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 TEVIE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification CIC, a y1e—
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORID
COUNTY OF 1°
ACKNOW++LED ED EFORE ME THIS L DAY OF ,20
BY. �W WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED (� Hck d i/wey It w*1's e- AS IDENTIFICATION.
e '
STATE O LORIDA,Coun of Lori A.DeSalm
NOTARY PUBLIC
STATE OF FLORIDA
SIGMA OF NOTARY SEAL `: Comm GG130649
Expires 10/20/2021
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(1/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014