HomeMy WebLinkAboutPERMIT RENEWAL REQUEST■ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
/jj[ar7a'0 ainnl I� (772) 462-1553 Fax (772) 462-1578 RECEIVED
AS
MINNVOS PERMIT RENEWAL REQuEsr F LB 2 0 2020
ST. Lucie County, Permitting
PERMIT NUMBER: I W I- a 4 ADDRESS: / P 7 0 % l /1 47V 0yl t-1 -T-L- /3 k_9 r
PS C r(,
3'IfC-7
I, "To's CV 4 C A L L C- _7'0 , 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 N ?� V-c o U1 F T/ 6"1 C
ao r-c-e ao au
0 DR OR CONTRA OR SIGNATURE DATE
A- k
Print Name
STATE OF FLO A
COUNTY OF I
ACKNOWLEDGED BE RE MEN� TIESS ,t)& DAY OF � 2�
BY l...l, C V WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED
STATE OF
SIGNA
FOR OFFICE USE ONLY:
AS IDENTIFICATION.
KAREN S. NIELSEN
State of Florida -Notary Publi
Commission # GG 29?A�4
My Commission Expires
June 12, 2022
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