HomeMy WebLinkAboutPermit renewal form 4 J
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DMSION
23M VIRCINIA AVE
FORT PEERCE,FL34M
(7n)462-1553 Fas(772)462-1578 RECEIVED
PERMIT RENEWAL REQUEST OCi242018
ST. Lucie County, Permining
PERMIT NUMBER: 7 ADDRESS: \eolFw St• ��-`�\>�-u-Gr=s
I, ¢�.. ✓�,- "'¢< ,am requesting that the above permit be renewed. I
understand that I rust schedule and p seTs all required inspections for the permit to be fna)ed. 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 )I t of VC-- Nl,� .d.��3
es
OWN EIUBL RQ-RCONIRAC O SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTYOF 0r- W c t4
ACKNOWLEDGED BEFORE NNE TIES DAY OF a-} 20XA .
BY �3 i{24 WHO IS PERSONALLY KNOWN TOAD OR
HAS PROVIDED F L O L AS IDENTIFICATION,
ATEOF FLORIDA,ConFANNA61AaRONEnB
nyl%IMYMM 10 W 0770Yf
SIGNATURE OF NOTARY RP"
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aalaBHlsatxwy PWBe tMaaaAxn
FOR OFFICE USE ONLY;
Number of Open Inspection:
Total Inspection:
(Divide open by total to get%ofopen inspections)
Parentage:
Original permit fee: x%open = S Reneuat fee
Example: [15 divided by 23=.65(%)] $175(pamit fm)x.65=St 13.75(renewal fee)
Revised? IM14