HomeMy WebLinkAboutPermit Renewal Requesti�
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA,AVE RECEIVED
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 JUN 1018
Permitting Department
PERMIT RENEWAL REQUEST St. Lucie County
PERMIT NUMBER:I 0 [ Oa, ADDRESS: 1 1 r S !�-' " I Rc'f &'e�
I, AAY�)CA 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 Pr.n'i e Gt Cl,AN rf
Ifex'i6 111t�ne
Print Name
STATE OF FLORIDA
COUNTY OF 5 T. L LLc l e
ACKNOWLEDGED BEFORE ME THIS 22 DAY OF , 20j-6-_
BY WHO IS PERSONALLY KNOWN TO ME ✓ OR
HAS PROVIDED
ST E FLORIDA,-County of
�..
. SI A OF NOTARY
AS IDENTIFICATION.
''''•• MICHAEL ADDEO
�• `" MY COMMISSION # GG035606
Y•3:r,
SEAL EXPIRES October 04, 2020
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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(pecmit fee) x .65=$113.75 (renewal fee).
Revised 7/21/2014