HomeMy WebLinkAboutPermit renewal request PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRG'DUA AVE
- - FORT PIERCE,FL 34982
CM)462-1553 Fax CM)462-1578
RECEIVED
PERMIT RENEWAL REQUEST
MAY 16 2018
ST. Lucie County, Permitting
PERMIT NUMBER ADDRESS: ``� 1 es In-SIA
am requesting that the above permit be renewed. I
understand that I muust.schedule and pass all required inspections for the permit to be finaled. Further,I
understand that this is a ONE TDIE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period_
Justification 'L ti�
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
C; C-A--t-��-
Print Name
STATE OF FLOI
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 'O DAY OF V�/lL�-f 120 `v
BY. cS('� �Cil Z WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �L r7Y l C�C� (I I V l\I CJ�i � AS IDENTIFICATION.
STAT OF FLORID County,of `-� t Lori A.DeSalvo
' A ' NOTARY PUBLIC
� STATE OF FLORIDA.
SIGNATURE E O OF F NOTARY
Y Ste- �': CorQMntlt G0130649
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(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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