HomeMy WebLinkAboutPermit renewal j �
_ I PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
( a- '
� BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
NOV 2'4 ;2020
PERMIT RENEWAL REQUEST Permitting Depart I en}
St. Lucie County
PERMIT NUMBER: 07 - 0126 ADDRESS: 4422 1 'i/woj' A 1.4
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,
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 CmryeAv by% r-ed &v-e-
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OWNERBLDR OR CONTRrTOR SIGNATURE DA' E
Arm"Alo �
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF �3Lp- 20 DZ
BY OSSI to ?a rtl7�Q 0 IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED �- fl �- AS IDENTIFICATION.
STATE OF FLORIDA,County of zzoz ZZ jegojop
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SIGNATURE OF NOTARY N H`J n vA WIE 13
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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)
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Revised 7/21/2014
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