HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND"CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34082
(772)462-1553 - Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST Nov.0 1�20
Permitting Department
St,Lucle County
PERMIT NUMBER: V"Kll1JRESS: � .
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1, M1G1'1AJ khQfoC,[,L ,am request ni g t a tthhe�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 w 40 l\ t,c) `-VVY-Al P-vqS
_ � l•1 f 2�2c�
O R/BLDR CONTRACTOR SIG ATURE DATE •"
-Print Name
STATE OF FLO A
COUNTY
ACKNOWLEDGED BEFORE ME THIS DAY OF J 20a�
BY �'��,�W� �' k WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED L L AS IDENTIFICATION.
STATE OF FLORIDA,County of '� •1-��
OE MMIE GIVENS
?*; My COMMISSION#GG 022023
�+ b:= JNES. 20
SIGNATURE OF ARY ± o P•' JM NcDecember 16,20
try PubNc Undawrlters
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