HomeMy WebLinkAboutPERMIT RENEWAL REQUESTrr99 �
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PLANNING AND DEVELOPMENT SERVICES DEPA72TME%(9
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 �'� 3 3d
(772) 462-1553 Fax (772) 462-1578 0
PERMIT RENEWAL REQUEST
PERMIT NUMBER: j( )r J-30 ADDRESS: I U( ba l(A n V-1 it r bir-
I, I b jGAY—P—uoc )3oe k \ , 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
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OW11tAMLDR OR CONTRACTOR SIGNATURE
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Print Name
S,
-7%6Vi G SCANNED
DATE
St Lucie County
STATE OF FLORIDA I
COUNTY OF S't LAj [t..(-,
ACKNOWLEDGED BEFORE ME THIS DAY OF / 20�
B Y ( nak,'
WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA, County of � �
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SIGNATURE OF NOT Y
IPu ,- DANIELLEGONCALVES
My COMMISSION # GG 232946
EXPIRES: June 27, 2022
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BondedThn'NoWry.Public Underxsaw
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