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) 462-15788 RECEIVED
. SCANN% PERMIT RENEWAL -REQUE T O C T 31 2018
Bly ST. Lucie County, Permitting
M Lucie u ijnry :
PERMIT NUMBER:MO-2--.0'ADDRESS: 317 0 (; Ve Ave
I, ONCSNO,-C ILOc- , am requesting that the above permit be renewed. I
understand Wat 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 CONTRACTOR SIGNA
�DV A14s � I1bQ
Print NanJ
STATE OF FLORIDA
COUNTY OF /R Ar +: n
-DATE
i
ACKNOWLEDGED BEFORE ME THIS '� �- DAY OF 20e
BY DOVCI )COR WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED
STATE OF FLORIDA,
SIGNATURE 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.
REER
RESEG260667SEAL r 20, 2022
Example: [15 divided by 23=.65(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21014