HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE ---
FORT PIERCE, FL 34982 CEIVED
(772)462-1553 Fax (772)462-1578
DEC 31 2019
PERMIT RENEWAL REQUEST permitting
ST. Lucie County,
y� SCANNED
PERMIT NUMBER: /tS� I' ()q I I ADDRESS: Z,ZO�—I S �� ems— � N ,,,. G,
OUiItY
I, am requesting that the above permit be renewed. I
understa hat 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 K,2,sQ Q � L,c �= i c', ve_ �(f
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OWNER7btbR OR CONTRACTOR SIGNATURE
2 e25���
Print Name
STATE OF FLORIDA
COUNTY OF Sk, \-\1
ACKNOWLEDGED BEFORE ME THIS 3 \ DAY OF @ C
1 2- - ;:-.`- VCN
DATE
20 i l
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED X_ AS IDENTIFICATION.
g TE OF FLORIDA,
NATURE OF NOTARY
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
.w�FL9••
-$
DEANNAMARIEGIVENS
MY COMMISSION # GG 022023
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19 o:
EXPIRES: December 16. 2020
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Bonded Thru Notary Public Underwriters
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014