HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 [-RE70EIVED(772)462-1553 'Fax(772)462-1578
o CPERMIT RENEWAL REQUES
ST. Lucie
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PERMITNUMBER ADDRESS:
I, A u k d A�j 2 Ufa<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 TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
r G�- r, ✓ - � V �Q ,�6
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FL DA
COUNTY OF . LNc.N-4,,
ACKNOWLEDGED BEFORE ME THIS a"� DAY OF a 20�a
BY pck,l\ t b WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �� _ AS IDENTIFICATION.
STATE OF FLORI County of
'�' NIY COMMISSIONDEANNAMAR#GGi 0222023
SIGNATURE OF N ARY �o EXPIRES., tsar 16,2020
'.,,? �g?• Bonded Ttn No�ry INc Underwfltem
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