HomeMy WebLinkAboutRenewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
J AN 1 2022
PERMIT RENEWAL REQUEST St.Lucie County
Permitting
ff PERMIT NUMBER:CAI )4-0�C�0 ADDRESS: I lI3 ey-eSS1-cr Ln • pi-c��(
I, GLSCL- - e5 ,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 EJ is 0 A bgn I d r -e-y ,
d�� L3 �2�zd
OWNE DR OR-CONTRACTOR SIGNATURE D TA E
Print Name
STATE OF FLORIDA nn
COUNTY OF • 1,
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY a ?'j P S WHO IS PERS ALLY KNOWN TO ME OR
HAS PROVIDED b,40t, Ck C• AS IDENTIFICATION.
STATE FLORIDA,Co
��SCyu;,'• Ai3DREY&HUMPHREY
r{n A 'rS
SIGNA RE OF NOT Y :k= PAY C(:PA�1iSS1J'4#t GG 300817
z^. f'4, .•>: EXPIRQh 6,2023
Uondc;d Tluu lic Underwriters,s�.G::: :A.:.z
----------------—---—---------------=------------------------------------------------------------------------------------—
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