HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 RECEIVED
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST MAY 2 0 20119
ST. Lucie County, Permitting
PERMIT NUMBER: 11 i �� ay 1 ADDRESS: 6 6,02 (A) C1 C45 nie V (?— I A D
y
I, o r)ck r-n. to , 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 N �-eto rl ym f -e_ � 1'Y� � � `V—I 1(1a i a I
OWNE LDR OR CONT C09 SIGNATURE
Shyro �(W.A-2C-
Print Name
STATE OF FLO)ZIDA
COUNTY OF k_ L O c 01
ACKNOWLEDGED BEFORE ME THIS °ZO
E!-,;,o-C;�0[9
DATE
DAY OF Qy . 20JI—
BY S'?%-- i' o YN '!� Ql-► ( Zc � WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED IV-L 4b L AS IDENTIFICATION.
STATE OF FLORIDA, County of
o< : ^=p,`• DEANNA MARIE GIVENS
l�,v,,.� ?' ' • My COMMISSION # GG 022023
SIGNATURE OF NO Y =,9., WAES: December 16, 2020
Bonded Thru Notary public Underwriters
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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(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014