HomeMy WebLinkAboutPERMIT RENEWAL REQUESTSCANNED
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
772) 462-1553 Fax (772) 462-1578
RECEIVO
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PERMT RENEWAL REQUE ST JAN 0 7 Z0197
ST. Lucie County, Permitting
PERMIT NUMBER: 90q (?7,:,J!� 2— ADDRESS: 2-30-5�i q.m q r;wel
uAd.��rsnd that I must schedule
understand that this is a ONE T
passing inspection during any si
Justification F-C) - <1A 0 &
, am requesting that the above permit be renewed. I
all required inspections for the permit to be finaled. Further, I
NEWAL and the permit shall expire should I not receive a
period during the renewal period.
OR CONTRACTOR SIGNATURE
Print Name -
STATE OF FLO!!A.
_ 1. 1
COUNTY OF
ACKNOWLEDGEDrFORE ME TIIIS
BY
HAS PROVEDED
STATE
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of op,
Percentage:
original permit fee: x
Example: (15 divided by 23=
Revised 7/21/2014
b-7 I I
DA'fE
DAYOF �Akl. - 20
"Y OWNTOME
WHO IS PERSON OR
AS IDENTIFICATION.
KAREN S. NIELSEN
4 St at e of Florida -Notary Public
4".
k Commission # GG 207484
9z' My Commission Expires
�rz 0' F
June 12, 2022
i inspections)
open = $ ��Renewal fee
$175(permit fee) x.65=$113.75 (renewal fee)