HomeMy WebLinkAboutPermit Renewal To:+17724621578 Page:2 of 2 2022-03-16 16:41:02 GMT 13212480443 From:Jaime Rodriguez'
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
.....:.,..::.,.....,. . FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
RECEIVED
PERMIT RENEWAL REQUEST
MAR 16 2022
St.Lucie County
Permitting ,�
PERMIT NUMBER:21�1� —(�y �� ADDRESS: o3;'6-5— NJ A I .4 Y� TIG fG.Z,
I;- ja-r w-C. �i u-z°� ;am requesting that the above pen-nit be renewed, I
understand that I must sctYedule 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 041(17� VWL r
U RBLDR OR CONTRACTOR SNNATURE D I'E
Print Name
STATE OF FL
COUNTY OF
ACKNOWLEDGED BEFOR)r ME THIS DAY OF �dY 20
BY NVHO IS PERSONALLY KNOWN TO ME V 'OR
HAS PROVIDED AS IDENTIFICATION.
TATE OF.FLORIDA aunty f
+ e Notery Pubic Stets at Fionde
Blanca C GavAlez
SIGNATURE O F NOTARY SEAL My 0ommmW HH 01s1�
q� Expnesoar4grj 4 .
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)
Reviscd 7%21i2014