HomeMy WebLinkAboutPermit renewal Request PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT MBER: f t13 6.-- ADDRESS: .J
I, ,�� / ,am requesting that the abovd per it b"r"ehewed. I Y�JJ/
understand that I in 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
OWNERBLD OR tO6TRkCjOR SIGNATURE DATE
/u
Print Name
STATE OF FLORIDA
COUNTY OF d d�ACKNOWLEDGED BEFORE ME THIS �y—DAY OF U " - 20
BY t LWHO IS PERSONAL KNOW�TO OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,Coun o - IGr C •a
C; .�p�YPU '.,, AUDREYB.HUMPHREY
1 =2;
SIGNA OF NOT 2/ SEAL I. , '`;, MY COMMISSION#GG 300817
EXPIRES:March 6,202 3
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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)
Revised 7/21/2014
RECEIVED
NOV 2 3 2021
St.Lucie County
Permitting