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 RECEIVED
PERMIT RENEWAL REQUESS T DEC 2 7 2018
ST. Lucie Countyf Permitting
PERMIT NUMBER: I ` 10 / ADDRESS: ��®� l�/GZeIR �SS� '�/T C�
I, Roo A'IGOfz , 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 monthF perioq,�luring the renewal period. �
Justification d' d'i n�
OWNERBLDR OR CONTRACTOR SIGNATURE
A
Iq® rua lW In �► /o V-1
Print Name
STATE OF FLORIDA
COUNTY OF \t,
ACKNOWLEDGED BEFORE ME THIS a4
42,
DATE
DAY OF Z C 20
BY�Ip .n�,1 �l Q h WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED AS IDENTIFICATION.
ATE OF FLORIDA, County of
SIGNATURE
FOR OFFICE USE ONLY:
cigtiv•''4:: DEANNAMARIEGIVENS
MY COg� ION # GG 022023
="A :' EXPI mber 16, 2020
%;;o �«•' Bonded Thru Notary Pubric Underwriters
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