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
SCANNED
PERMIT RENEWAL REQUEST BY
St Lucie County
PIERMIT NUMBER: U ADDRESS: q60 �lVr
I, 1 '14{ 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 laQ fa jg, C, e-New WG e,
A 11q
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
i
fZSSRC /�(Dfl Ci
Print Name
ST&E OF FLORIDA
COUNTY OF-1,a.a-s A�
ACKNOWLEDGED BEFORE ME THIS \Q DAY OF 20 19
BY 1 ZQ!9�_ � WHO IS PERSONALLY KNOWN TO ME OR
HASIPROVIDEDAS IDENTIFICATION.
IZ
l
S I E OF FLORIDA County of nos.
S GNATURE OF NOTAR
W.." LASHMNAINGRAM-RAVIMING 5060
MY COMMISSION # GG
OFFICE USE ONLY:
I --
Number of Open Inspections:
Total Inspections:
(Divilde open by total to get % of open inspections)
Percentage:
Origii al 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