HomeMy WebLinkAboutPERMIT RENWAL REQUESTSM.
L.
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE.
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 r RECE I VEE®
PERT RENEWAL REQUEST 1 APR 2 3 ?QPERMIT
ST. Lucie County, Permitting
PERMIT NUMBER: l D 6 J ADDRESS: G
I, i l(�I FMCS �'�t� lo► c� o , am requesting that the above permit be renewed. I Se"4-
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I '
und��erstand 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. 3
,I , N _1 I -A --I
J
IMLDR OR C N RACTOR SIGNATURE
Name
ATE OF FLORIQA �v�\
)UNTY OF
�/2310
DATE
:NOWLEDGED BEFORE ME THIS a3 DAY OF .20
WHO IS PERSONALLY KNOWN TO ME OR
i PROVIDED rr L O L. AS IDENTIFICATION.
.TE OF FLORIDA, County of S�' • �— VC .\
DEANNA MARIE GIVENS
MY COMMISSION # GG 022023
NATURE OF NO 1 Y :a - •SEAKPIRES: December 16, 2020
Bonded Thru Notary Public Underwriters
5 uu
FOR OFFICE USE ONLY:
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)
Revised 7/21/2014