HomeMy WebLinkAboutPermit Renewal Request ( 8-23-2016 )PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVIS
2300 VIRGINIA AVE 0 C 1 VIE D
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 AUG 2 3 2016
PERMIT RENEWAL REQUEST PEi.10rrTING
St. Lucie County, FL
ADDRESS:
I, 'Dar( lbukz\ C , am requesting that the above permit be renewed. I
understand that I must schedule and pass, allrequired 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 0W'C)-4Z Z
SIGNATURE
Print Name
STATE OF FLORIDA
COUNTY OF &- LAt-A
8(i!5--/1(.
DATE
ACKNOWLEDGED BEFORE ME THIS 1-'Y -'� DAY OF
BY D OACA . DclrXC-4- \ WHO IS RSONALLY KNOWN 0 ME , OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA, County of L uC t is
of RoMa
ysr Notary F++O>io Stets
Brenda Rando•Newell
• My Commission FF 951312
ATURE O , TARY S p�d� Ev#wsovi91A20
FOR OFFICE USE ONLY:
Number of Open Inspections: q
Total Inspections: ct
(Divide open by tot tc et % of open inspections)
Percentage: O -
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