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
44 PERMIT NUMBER: �003 " OZSS ADDRESS: `7 b /vJ 4
1, A-M44-dc) " `l V( ,am requesting that the above permit be renewed. I
understand that I must chedule 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 monthperiod during the renewal period.
Justification 6 c/}'� Cam— 666; ?
OWNER/BLDR OR CO TRACTOR SIGNATURE bATE
X/ Ma/r
gy
Print Name
STATE OF FLORIDA /
COUNTY OF � e
ACKNOWLEDGED BEFORE ME THIS DAY OF 20.P
BY��// !� J� WHO IS PERSONALLY KNOWN TO ME G— OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of ���• /%� RllTH L LOPQ
, #NCOMMION GG 29497 1
SIGNA NOTARY SEAL r EXIRES:danu424,2023
8ordW7AruNotuyU1d0r*Fft o
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
DEC 4 2021
St.Lucia County
Permitting