HomeMy WebLinkAboutPERMIT RENEWAL REQUEST 10-15-19a q
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Ab 0 e `� s' BUILDING AND CODE REGULATIONS DIVISI
2300 VIRGINIA AVE RECEIVE®
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FORT PIERCE, FL 34982
(772)462-1553 Fox (772)462.1579
OC I 1 5 >�
PERMIT RENEWAL REQUEST M!', W4@ County, pormitting
PERMIT NUMBER: ISU `:a L ADDRESS: .J �Oall M
I, 4� ri;� �t- , am requesting that the above permit be renewed. I
un erstand that I mtWt schedule and pass all required inspections foir 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 inspectioq during any six Morltlj period during the renewal period. SCANNEED
0y
St Lucie County
IC) Zy0/I4
DATE
&6�,
h�
Tint Name
STATE OF FI:o�
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS � _ DAY OF F 2011—
BY ep% e WHO IS PERSONALLY KNOWN TO ME . OR
HAS PROVIDED AS IDENTIFICATION.
ST RIDA, County of c�' (Yl oo l'Q KA'jHLEEN O RIVERA
i ogn1> I71A _ NOTMt COMMISSION
NGG59903
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SIGNATURE OF NOTARY SEA m DMAES Un. 24, 2021
ALA UGUQANCE COWAM
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 - S Renewal fee
Example: [15 divided by 23-.65(0/o)] $175(permit fee) x .65=$l 13.75 (renewal fcc)
Revised W=014
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