HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING ANDiDEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
1(772)462-1553 Fax (772)462-1578
BY
St Ltuft C&MV PERNIIT RENEWAL REQUEST
�$0 5 a33
PERMIT NUMBER: ADDRESS: 0 O R (5QM
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I, TO S a 10 am requesting that the above permit be renewed. I
understand that I must schMileand pass all rgquired 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
OWNER/BLDRff OR CONTTOR SIGNATURE
-NU Kr iI
Print Name
i
i
STATE OF FLORID
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS
BY n n 1
HAS PROVIDED
STATE OF FLORIDA, County of
FOR OFFICE USE ONLY:
DATE
Y OF 120
IS PERSONALLY KNOWN TO ME , OR
Number of Open Inspections: I
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open i $ Renewal fee
AS IDENTIFICATION.
SEAL
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal
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Revised 7/21/2014 i
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RECEIVED
JAN 0 9 2019
Permitting Department
St. Lucie County, FL