HomeMy WebLinkAboutPERMIT RENEWAL REQUEST1
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
CANNED PERMIT RENEWAL REQUEST
BY
St Lucie County
PERMIT NUMBER: 141 ADDRESS: ILZ 7L
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
O L R OVONTRACTOR SIGNATURE
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Print Name
DATE
STATE OF FLORIDA
COUNTY OF �r
ACKNOWLEDGED BEFORE METERS k�DAYOF_;�iA 20
BY Q WHO IS PERSONALLY KNOWN TOME , OR
HAS PROVIDED F\ AS IDENTIFICATION.
S TE OF FLORIDA, Countyof r n � 'r'ape� ,�' l ASN is - INGRAM
� a°, t o. Notary Public -State of Florida
�46« «• My Comm. Expires Dec 20, 2018
=;�° ` Commission # FF 177249
I TURE OF NOTARY SEAL 9f
° �`�` Bonded through National Notary Assn.
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open bytotal 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 721/2014