HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
s
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST FEB 012022
St.,Lucle County
Permitting
PERMIT NUMBER: �l U� .4Z/�� ADDRESS: (-K C'a/"9 CQ Z) R
1,6/--T' Ple/ - �� 3 �y��,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 Oh
- 7 - -a
OWNERBLDR OR CONTRACTOR SIGNATURE L DATE
Print Name
STATE OF FLORIDA
COUNTY OF S-I-.bx'y@—
ACKNOWLEDGED BEFORE ME THIS 1 DAY OF `n .20a'o\
BY 6't�1c)dr•t. LO Q�Z WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED 1. L AS IDENTIFICATION.
STATE OF FLORIDA,County of
-MU°�"•. DEANNA GIVENS
?° ���, Notary Public-State of Florida
ems`•' Comm' #HH 086359
SIGNATURE OF NOT E; n
My Comm. xp res Jan 28,2025
_ Bonded through National Notary Assn.
7------------------------------------------------—----------------—--------------------------—-------------------------------------------------------
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
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