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HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISIOD 2300 VIRGINIA AVE FORT PIERCE, FL 34982 BY (772) 462-1553 Fax (772) 462-1578 1 !it ?-j1r.1P rWWAO'i PERMIT RENEWAL I RECEIVED JAN 0 7 2019 ST. Lucie County, Permitting PERMIT NUMBER: SS 1 —7 ©y '—y 1 S 3 ADDRESS: W � 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 'Pa`� 0 ERBLDR OR CONTRACTOR SIGNATURE Print Name b-7lr? DATE 4 STATE OF FLO D COUNTY OF �J I a ACKNOWLEDGED BEFORE ME THIS ' / DAY OF 120 19 p�� I ` BY L t" �I oMA111M orl WHO IS PERSONALLY KNOWN TO ME OR AS IDENTIFICATION. ,,,��P;;e,,, KAREN S. NIELSEN =o ',State of Florida -Notary Public SEA =+ +� Commission # GG 207484 °V' My Commission Expires 9 OF U `� 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) FOR OFFICE USE ONLY: Revised 7/21/2014