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HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982�;<U� (772)462-1553 Fax (772)462-1578 AUG 2 3 2019 PERMIT RENEWAL REQUEST ST. Lucie County, Permitting PERMIT NUMBER: lC�s 11)' O ©� ADDRESS: ` 5OV4� —'R\tj h7J "alb I, 64 M60r—t4 � , 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 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/BLDR OR CONTRACTOR SIGNATURE DATE e.� c 45 MOG�P— l✓!91qb Print Name STATE OF FL COUNTY OF I q ACKNOWLEDGED BEFORE ME THIS DAY OF V 20 1 BY 1 VC �- nQ WHO IS PERSONALLY KNOWN TO ME -�-6R- ,,,„ = =oirp; MARYT. LORD WCOMMI88101 FF985058 4 11 EXPIRES:AV924 2020 a` B0riMTM10UrKkWW11� M M --------------- 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