HomeMy WebLinkAboutrenewal requestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY '*
i L C! R 1 D A
PERMIT NUMBEk: 2108-0801
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
ADDRESS: 1133 Nettles Blvd Jensen Beach
1, Vance R Corbin 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. St Lucie Co
Vcjtt� 1/13/2022
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Vance R Corbin
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE, ME THIS L-�) DAY OF --J MU5- K 'M 20;L a
BY K. a " 'WHO IS PERSONALLY KNOWN TO ME :V.1 OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA, County of
SIGNATURE OF NOTARY 1211212625
------ ---------- —---------------------- —-------------------------- ---- y _u�lt� tc�� T
FOR OFTICE USE ONLY:
49Carlimiq.,r�
Number of Total Inspec�en Inspections:
Inspections
(Divide open by total to get % of open inspections) ,
in
}-�
Percentage:
Original permit fee: x % open = $ Renewal fee
Example: [15 divided by 23=.65(°fo)] $175(pennit fee) x .65=$113.75 (renewal fee)
.Revised 7/21/20I4