HomeMy WebLinkAboutPemrit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL34982 RECEIVED
(772)462-1553 Fax(772)462-1578
FEB 0 9 2018
PERMIT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER: �I,C, /701J O� �'7/ADDRESS: �7 ` K rIC'h�s �'J� tFe i z
I, PC4t�2Ce I^4 h M 5 o/'!i ,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
20/S
OWN LDR OWCCtPkACTOR SIGNATURE DATE
14W-W
Print Name
STATE OF FLOIYqA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS-DAY OF 204—
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF LORID ounty f I KAREN S. NIELSEN
Commission # FF 115637
6 Al My Commission Expires
SIG ATWE OF NOTARY SEAL ;; June 1 2, 2018
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage: cc
Original permit fee: x%open = $ 1 _Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014