HomeMy WebLinkAboutPERMIT RENEWL REQUESTCQUN�Ye- _•
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PLANNING ANMauL (�D DEVELOPMENT SERVICES EPARi TMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINLA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST SCANNED
BY
St Lucie County
PERMIT NUMBER: t7 J� ADDRESS: a% t j3
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am requesting that the above permit be renewed. I
iderstand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
lderstand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
rising inspection during any six month period during the renewal period,
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DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS .iCl DAY OF �Ie 20 �
BY ,+P—�"� �PS R'HO IS PERSONALLY KNOWN TO ME_.- N ' OR
HAS PROVIDED
STATE OF FLORIDA, County
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Sl i'•UK'OF Np', RY
FOR OFFICE USE ONLY:
Number of Open Inspections: _
Total Inspections:
(Divide open by total to get % of open inspections)
Pence Cage:
Original permit fee: x%Open = $ Renewal fee
AS IDENTIFICATION.
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Example: [IS divided by 23==.65(%)] $175(permit fee) x .65=$ I l3.75 (rene%val fee)
Revised 7/21/2014