HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
:fh VP BUILDING AND'CODE REGULATIONSDIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: I ? V � - fl �DSADDRESS:
6'-�->c (5-b64 3 d C- WT -
I, , 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
OWNERBLDR OR CONTRA�CTO�R SIGNATURE
Print Name
DATE
8-
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
By 91
y he e—+ Sm p4hh . wHo IS PERSON KNOWN TO E , OR
HAS PROVIDED - AS IDENTIFICATION.
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
TEAL
<StiY ey' •., AUDREY B. HUMPHREY
MY COMMISSION Y FF 174772
CC
EXPIRES: March 6, 2019
9=
Bonded Thru Notary Public Undenvr!ers
Renewal fee �t
A
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal
Revised 7/21/2014
RECEIVED
APR 11 2018.
Permitting Department
St. Lucie County, FL