HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
e 2300 VIRGINIA AVE
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FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 RECEIVE®
JUL 17 2019
PERMIT RENEWAL REQUEST
5l": l=.gcib county, permitting
PERMIT NUMBER: A M V P- l 1M ADDRESS: 1 11 U► i C Q Pr eme F
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I, am requesting that the above permit be renewed. I
understand that I must chedule 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. SCANNED
Justification BY
St Lucie County
OVv'fqER/fLD1rOR CONTRACTOR SIGNATURE
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STATE OF FLORIDA
COUNTY OF t '\e-
ACK,NNO`WLEDGED BEFORE ME THIS �A DAY OF 75 J 20
BY Y1 ` JQ r �q VA Q �Z'r+ 11�C� WHO IS PERSONALLY KNOWN TO ME , OR
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HAS PROVIDED �' L L AS IDENTIFICATION.
STATE OF FLORIDA, County of� L J """ DElWNA k9FlR!E GNEPdS
� '?' MY CC)INP�IISSION � C3Cy Ox2,023
w.�:o ` EXPIRES: Drcamb�:r 96, ?020
SIGNATURE OF NOT Y F�F F�� Bon9l+ru Pdot2ry Pubfia Underwriters
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Origi I al permit fee: x % open = $ Renewal fee
i
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revisetl 7/21/2014