HomeMy WebLinkAboutPermit Renewals f
i
i
_ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
J BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fa.x(772)462-1578
PRECEIVE®
PERMIT RENEWAL REQUEST
DEC 17 2018
ST, Lucie Co�Ir�tYt Permitting
PERMIT NUMBER: q C> ADDRESS: .5 5!g?a LAe, 4,(A 1 L.
1, iZaAe%j�tt_ t3 Z!�>_S cD L_'bs ,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
1-S
0 ER/BLDR OR CONTRACTOR SIGNATURE DATE r
Print Name
STATE OF FLORIDA
COUNTY
ACKNOWLEDGED BEFOREHI ME TIES `� DAY OF zc—
`
BY �` 1ok WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �' L' AS IDENTIFICATION.
— I
STATE OF FLORIDA,County ofDEANNA I
�1.Au.
MY COMMISSION#GG 022023
EXPIRES:December 16,2020
o ' BonWa46 Notary Public Underwdtom I.
--------------------------------------------------------------------------------------------------------- -
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
i
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
1 Revised 7/21/2014
I
I