HomeMy WebLinkAboutPERMIT RENEWAL REQUESTBY
PLANNING ANDCWEVEO NENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
NUMBS / u oa 0
understand that I must schedu:
understand that this is a ONE.
passing inspection�jiring any
Justification
2300 VIRGINIA AVE
FORT PIERCE, FL34982 RECEIVED
(772) 462-1553 Fax (Ta) 462-1578
PERIVIITRENEWALREQUEST DEC 2 6 2018
ST. Lucie County, Permitting
Z�
)DRESS:
am requesting that the above permit be renewed. I
luired inspections for the permit to be finaled.. Further, I
AL and the permit shall expire should I not receive a
l during the renewal period.
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLO
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS " DAY OF 20-Z—
BY - ? - a_ �j z e S WHO IS PERSONALLY KNOWN TOME , OR
641 1
HAS PROVIDED
of
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
AS IDENTIFICATION.
JpNE'L.CONNER
I :��r c �'�.,
ti0 ���;% _Notary, Public - State' of Florida
S Q •E Commission # GG 036070
My Comm. Expires Dec 10, 2020
1 1
'shoO`o` Bonded through National Notary Assn
Example: [15 divided by 23=.65(0/o)] $175(permit;fee) x .65=$113.75 (renewal fee)
Revised 7I21I2014