HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTME�
l�xJ. BUILDING AND CODE REGULATIONS DIVISION
i300 VIRGINIA AVEC
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
NOV 2 Q 2017
PERMIT RENEWAL REQUEST PEW111TT1i4G
St. Uucie'County, FL
pp ��pp 1 � �33 � •
PERMIT NUMBER: ADDRESS: �• i � ��"� ��'�'Z
I, �Gl� G 114"1'4_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 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 ���� G �-�c� L4��
OWNEFAZLDRORCONT TOR SIGNATURE DATE
Print Name
STATE OF FLORI A`
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS_ DAY OF 20
BY ] �{�°,� `d llf'I WS WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED ��L AS IDENTIFICATION.
STATE OF LORIDAI County of
I OAA cr— ,
KAREN S. LIEN
SIGNATURE OF NU
Commission k FF 115637
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My Commission Expires
June 12, 2018
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 = $ pO Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014