HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(172) 462-1553 Fax (772)462-1578 V RECEIVED
PERMIT RENEWAL
NG'd 0 8 2018
ST. LUCIe County, Permitting
PERMIT NUMBER: IADDRESS.:Ely
t.I
I; 014V /0 6AI , am requesting that the above permit be renewed. I
understand.that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE. TQ1E RENEWAL and the permit shall expire should I not receive a
.passing inspection during any six month period during the renewal period.
Justification
OR
Print Name
f11Z1113
DATE
STATE OF FLORIDty / ,,,[
COUNTY OF 11 li
ACKNO DGED E RE THIS �_ DAY OF a �� �� 20 17
BY Q th � � " " WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED D.4 ��� I ( eAl-�— AS IDENTIFICATION.
STATE 0 unty of oe, ` tpRy,q� Erich Daniel Krach
o� NOTARY PUBLIC
Cam_ STATE OF FLORIDA
SIGNKTURE OF NOTARY I SFAL �.` ` i Comm# GG10'5925
�NCE 19Expires 5/17/2021
FOR OFFICE USE ONLY:
ier of Open Inspections:
Inspections•
le open by total to get % of open inspections)
ge: �
permit fee: x %. open = $ _L6LL-_Renewal fee
[15 divided by 23=.65(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
7/21/2014