HomeMy WebLinkAboutPERMIT RENEWAL REQUESTSCANNEDBY
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Lucie Comb/
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
—
BUILDING AND CODE REGULATIONS DIVI ION RECEIVED ja
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 Q p R l$ 2019
(772) 462-1553 Fax (772) 462-1578
ST. Lucie County, Permitting
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1 OV I 01Q63 ADDRESS:
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J�NIR�NCIQ,Q.E,� , am requesting that the above permit be renewed. I
znderstand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
znderstand that this is a ONE TIME RENEWAL'and the permit shall expire should I not receive a
)assing inspection during any six month period during the renewal period.
Justification M ' oecrti
'ki G
)WN LDR OR CONTRACTOK SIGNATU DATE
'rint Name
4-
;TATE OF FLO
,OUNTY OF
ACKNOWLEDGED BEFOREgVIE THIS DAY OF 20
3Y V WHO IS PERSONALLY KNOWN TO ME OR
IAS PROVIDED L AS IDENTIFICATION.
;TA TE OF LORID%nty f 1
KAREN S. NIELSEN�
_ ;State of Florida -Notary Publics
Commission # GG 207484 I
;IG14ATUREOFN ;b V ALMy Commission Expires
June 12, 2022
OFFICE USE ONLY:
umber of Open Inspections:
Aal Inspections:
)ivide open by total to get % of open inspections)
permit fee: x % open = $ _Renewal fee
[15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
7/21/2014
�b r-t 'p, '6t"C.e f 1 3 41 q - RECEIVED
APR 18 2019
ST. Lucie County, Permitting
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