HomeMy WebLinkAboutPermit Renewal RequestPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
RE
MAR 2 9 'LO98
(� /� ST, Lucie County, Permitting
PERMIT NUMBER: O V J V 3 Ci ADDRESS: R i r yi eCiC f
I �'T�►/�lPP� , 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 pen -nit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
3` q5
Justification Ul e Gc S46 NOT A-(, keg A �'��Q�r� WffO AF91V f�s'keO e 4N6"e UJ6
4�e4
FAR
OWNERBLDR O ONTRACTOR SIGNATURE IYATE
Print Name
STATE OF FLORIDA
COUNTY OF 'L4^
ACKNOWLEDGED BEFORE ME THIS DAY OF //f/7M% 120 U
BY -- l Z4& / WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED
STA.'FE OF
of rXIN
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
AS IDENTIFICATION.
F N1vRPHY
•" MY COMMISSION # GG131871
EXPIRES September 22, 2021
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014