HomeMy WebLinkAboutPermit Renewal RequestACKNOWLEDGED BEFORE ME THIS
BY
HAS PROVIDED
OF FLORIDA, County of.
FOR OFFICE USE ONLY:
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL -REQUEST
PERMIT NUMBER: // 1_ u—" 3 o V ADDRES S: 101 C% l Mo-,C D r iy e-
I, 46re4i 2cu rn a v-� , 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,
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 510W (�en� -I Co►� r0.cf-ov pQ1oaM2
r
OWNERBLDR OR CO TOR SIGNATURE —TDATE
_Kar•e n Towm an
Print Name
STATE OF FLORIDA , r
COUNTY OF r
VDAY OF
WHO IS PERSONALLY KNOWN TOME , OR $ 4
x� c
f AS IDENTIFICATION. 2 :5
SEAL' cO N
m
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(0/o)l $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212614
RECEIVED
NOV 30Z018
Permitting Department
St. Lucie County, FL