HomeMy WebLinkAboutRenewal Letter PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
N3. ��-7 �' -_ BUILDING AND CODE REGULATIONS DIVISION
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2300 VIRGINIA AVE
FORT PIERCE,FL 34982
ocejvVID (772)462-1553 Fax(772)462-1578
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10 0 meat PERMIT RENEWAL REQUEST
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PERMIT NUMBER: C21 o1 —62 LOIlo ADDRESS: Za(a /1f��-fly 13It/ �f nsL12 �r1? ��3y9��
I, `�-c �fs,�' r� i��✓► ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be frialed. 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 •�i7r 1�a �Dcyn a���o /�i��1� ,�j c s c�o .� i�i s�if� f ,
®R/BLDR ZC�CTOR TURE DATE
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Print Name J
STATE OF F£ORftt
COUNTY OF
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ACKNOWLEDGED BEFORE ME THIS DAY OF
BY C/y
WHO IS PERSONALLY OWN TO ME OR
HAS PROVIDED. Pl oyi d Q Nnn `l l� n/ /c AS IDENTIFICATION
M STA OF \�� � Q rl •F� /J S
County of ,UIM 10 3 "
Faith 0ddridd=
SI ATURE OF NOTARY Notary Publics':lillichigi3rit5
SEAL Macomb Coun
My Commission Expires Feb 2028
- — ---- ---------_----_-------
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 by23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014 RECEIVED
JAN 2 6 2027_
St.Lucie County,Permitting