HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
10 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
SCANNED PERMIT RENEWAL REQUEST
B
sie LoaGounty
PERMIT NUMBER �� �`�r0 ADDRESS: a5' �O�YiSI T e
am requesting that the above permit be renewed. I
nderstand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
nderstand 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.
SIGNATURE
Name
L�-z.a ) I I
ATE
.TE OF FLORIN 1 ��
JNTY OF VJ
:NOWLEDGED BEFORE ME THIS -2L\ DAY OF
W �I��CSIJ'(Y1 MQ—Qj`C(�\D\-5, WHO IS PERSONALLY KNOWN TOME , OR
i PROVIDED 1 AS IDENTIFICATION.
.TE OF FLORIDA C%unty of 9 . _ _ W CZ'
SEAL
OFFICE USE ONLY:
)er of Open Inspections:
Inspections:
le open by total to get % of open inspections)
ntage:
ial permit fee: x % open = $ Renewal fee
ple: [15 divided by 23=,65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
17/21/2014
APR 3 ® 2019
Permitting Department
St. Lucie County, FL