HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RECEIVED
PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
AUG 21 2019
PERMIT RENEWAL REQUEST ST. Lucie County, Permitting
PERMIT NUMBER Q )0 - )32-n ADDRESS: I 1—I Gueen FUce�.-)ku
I, �ay e. CCsw C�0— 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
OR CONTRACTOR SIGNATURE
91a►re,
Print Name
STATE OF FLO DA �� r
COUNTY OF C
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 l C 1
BY ��Q C� ,(� WHO IS PERSONALLY KNOWN TO ME, OR
PROVIDED
OF FLORIDA, County of
.. _ w .. I r\-.,. - . , .
TURE OF NOTARY
OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
r cL �un"8c. Original permit fee: x % open = $ �r
�Renewal fee
'CANNED
St Lucre Countylf
y
AS IDENTIFICATION.
k - , ,, DANIELLE GONCAI-VF-S
*. MY COMMISSION # GG 232946
EXPIRES: Juno 27, 2022
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Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014