HomeMy WebLinkAboutPERMIT RENEWAL REQUESTSPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
� BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
L y FORT PIERCE, FL 34982
E B �l E ® (772) 462-1553 Fax (772) 462-1578
DEC 1 5 2016 PERMIT RENEWAL REQUEST
PERMITTING
St. Lucie County, FL
7
ng that the above permit be renewed. I
ctions for the permit to be finaled. Further, I
understand that this is a C
passing inspection during
4��J" J4"';j . � / �'Ir"111�� St (ucia y
OWNER/B OR CONT CTOR SIGNATURE DATE CI e County
Print Name
STATE OF FLO A
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS �_ DAY OF I�Nr • . 20
�\ Lho WHO IS PERSONALLY KNOWN TO ME .OR
BY '�HII�
HAS PROVIDED
STATE OF
AS IDENTIFICATION.
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=$113.75 (renewal fee)
Revised 72WO14
KAREN S. NIELSEN
Commission F FF 115637
My Commission Expires
June 12. 2018
ry,
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGUI:ATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 467,1553 Fax (M) 462-1578
PERMIT RENEWAL REQUEST
PERMITNUM13ER: 1501-W2-1-' ADDRESS:,I S lX.CAW 0-12-7
7&rO6�� . am re4uestin that the above permit be renewed. I
understand that I musf schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the�rel[f,�ewal period.
T„.f;fi,.Ni "Q tin ZN !1 6N/O,K4 G✓tiv ,I J
OWNEMLDRPR CONTRACTOR SIGNATURE DATE
r, .4 fee -
/Print Name
STATE OF FLORID 1JJ•/�' I
COUNTY OF "'"'--1—I
ACKN IiED fBE�FORE ME DAY OF � !
gy / WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED AS IDENTIFICATION.
STA 0 • FLORH)A, County of
C/ rf?)V+nce,,,aryPuklic State ofFloridaSIONA OF NOTARY aonzaoma'" GG 092440
'01,
FOR OFFICE USE ONLY:
F4PIYEjS:- 611511$
Number of Open ons: `
Totallnspections:
(Divide open by 1 to get % of open Inspections RECEIVED
Percentage:
Original Permit fee: x%open $ T, R ewalfee MAY 31 2018
Example: [15 dlvlded by 23=.65(°�)] $175(p Y 65=$113.75 (renewal fee)
ST. Lucie County, Permitting
Revised 7/212014