HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 RECEIVED
PERMIT RENEWAL REQUEST JAN 0 7 2019
ST. Lucie County, Permitting
PERMIT NUMBER: ADDRESS:
I,s j min w cc�, Wto , 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 for,,, E- 10ANNED
CONTRACTORSIGNATURE
Print Name
'D I /a-1 1
DATE
STATE OF FLO
COUNTY OF
ACKNOWLEDGED1FORE ME THIS _DAY OF �� . 201q
BY��� �YV1_ WHO IS PERSONALLY KNOWN TO ME ✓ I , OR
HAS PROVIDED
STATE OF
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: r
Original permit fee: x % open = $ r7 �. Renewal fee
AS IDENTIFICATION.
C®MY
KAREN S. NIELSEN
-,State of Florida Notary Public
•= Commission # GG 2 77484
�, My Commission Expires
SEAL12, 2022
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014