HomeMy WebLinkAboutPermit RequestPLANNING 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: )60 3 - Oa�(oO ADDRESS: '5'500 ,' Uty A4
I, O''Ido L S 701g,�& , am requesting that the above permit be renewed. I
understand that 1 must scIfedule 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 - '�
OR CJSNTRACTOR SIGNATURE
�--,�a,r4 gew" TbieA
Print Name
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-2/2 /
DAT
STATE OF FLORIDA
COUNTY OF �- j!,lGj
ACKNOWLEDGED BEFORE ME THIS c� _ DAY OF % )eCcFj1n 9P .20c/�
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BY yOfI7191WO 7Ce" & v D WHO IS PERSONALLY KNOWN TOME ✓ OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLOrA, Countyof - ' j .
w COMMISSION # GG 294971 a
SIGNA NOTARY SEAL EXPIRES:Jvwyy24,2023
%';ors�?�`'a BOf1AEdi1WN6teryPubfiCUntteMrt••
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 RECEIVED
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee) DEC U 2 2021
Revised 7/21/2014
St, Lucie County
Permitting