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: OR s q ADDRESS: 44 6za 14, A 14-
I, a vidV &gg S /'�1(2d-a ,am requesting that the above permit be renewed. I
understand that I must§6hedule 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
nnany
__six month period during the renewal period.
Justification c 'L "r `T�i c�P�ici2aL.
OWNERBLDR OR CONT CTOR SIGNATURE DAT—
�vY�Gyrt c�-o ���
Print Name
STATE OF FLORIDA
COUNTY OF ''� Cle � l
ACKNOWLEDGED BEFORE ME TES DAY OF 20 0•/
BY �' l2?/� 7/ WHO IS PERSONALLY KNOWN TOME (/ OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF F /A,County of ��/ ,••.. RUTH L.:#GG
a s W COMMISSIO 294971SIGN. F NOTARY EXPIRES:Jan ,2023SEAL ';;* °`�••' gq ThnlNolarynderwan
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 7/21/2014FF����
DEC 0 2 2021
St.Lucie county
Permitting