HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
MIJE �� `' �� BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE, FL34982 RECEIVED
(772) 462-1553 Fax (772) 462-1578
sly JAN 0 7 2019
PERMIT RENEWAL REQUES O T. Lucie County, Permitting
PERMIT NUMBER: �� dZ� ADDRESS: L3 7 r 42L ff-e YlS /-1
I,
a "- �o �-�y` , 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 �v b s JP k�u,
}Z/ELDR OR CONTRACTOR SIGNATURE
VL. <,v C-<aj V Vk-'--)-4�
Print Name
&1��l�
DATE
STATE OF FLO I
COUNTY OF ,
ACKNOWLEDGED BEFORE ME THI. S r _ DAY OF j A t 20
BY c�nl T \1�!'lUl.1 WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED
STATE OF LOR3Coun of
SIGNATURE OF NOTARY
FOR OFFICE USE ONLY:
AS IDENTIFICATION.
K A R E N #.j-i N-
state of Florida -Notary Publi
Commission # GG 2074,94
My Commission Funir��
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: i
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