HomeMy WebLinkAboutRENEWAL 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 NUMBER: d 07 3- ADDRESS: ` v / A' Y S�
I, �>A y c� i A Na erfe.4j ,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
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
_�)oj✓t'j J ��'2�1��
Print Name .
STATE OF FLORIDAZ �f
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF �` ,20 1
BY:T)�J 1 p • WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED f). AS IDENTIFICATION.
STATE OF FLORIDA,County of
SIGNA RE OF NOT SEAL
_`tom'-,•2e.?xe(:.".,. , ----------
:t u�,
FOR OFFICE USE ONLY: si r `;t MY COMMISSION i#GG 3008V
EXPIRES:March 6,2023
Number of Open Inspections: nded Thru Notary Public underwriters s,
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: L15 divided by 23=.65(%)� $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014 DEC 0 2 2021
St.Lucie County
Permitting