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 REQUEST MAY 16 2019
ST. Lucie County, Permitting
PERMIT NUMBER: 11 1 �' d�� ADDRESS:
I, Jo h A W V' L^ , am requesting that the above permit be renewed. I
understand that I muW 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 !�1 �i,n� ��ird C7I V 614P_ . d ttA ,f-/1►' JIu aA Ak i^ kmjc e
SIGNATURE
/ �() �n Wte �4a•.�
Print Name
STATE OF FLORIPA
COUNTY OF SS • 1—Jc��
ACKNOWLEDGED BEFORE ME THIS % DAY OF m
d/, A0/
DAM
20_L
BY �5 00% f, Nh�"\ •d'VSa wl WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED L %0 l" AS IDENTIFICATION.
TE OF FLORIDA, County of 5 T . L i1 C
SIGNATURE OF NOT
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
DEANNA MARIE GIVENS
MY COMMISSION # GG 022023
EXPIRES: December 16, 2020
SEATIed Thru Notary Public Underviriters
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014