HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 O C T 19 2021
St.Lucie County
PERMIT RENEWAL REQUEST Permitting
1 1VVV
PERMI NUMBER: � ADDRESS: V
am requesting that the above permit be renewed. I
unders and 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 P Gamlk cl)yk ( �� 1/l Ql� G� l V"u
O LD R CONTRACTOR SIGNATURE DAT
Print Name
STATE OF FLORI,
COUNTY OF Q,1 • )'�'�
ACKNOWLEDGED BEFORE ME TTMS��DAY OF 20 C 1
BYYYI t — ��� WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED ��� AS IDENTIFICATION.
STATE OF ORIDA,C1,1nof "YP/ KAREN S. NIELSEN
.�` �e,
State of Florida Notary Public
Comrrtission# GG 207484
AN
S OF NOTARY 29,E ae My Commission Expires
SIGNATURE
SE ° ,;,. June 12, 2022
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