HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• Building and Code Regulations Division
2300 VIRGINIA AVE.
FORT PIERCE, FL 34982
(772)462-1553
PERMIT RENEWAL REQUEST SCANNED
BY
Paint ci L, St. Lucie Coun
ty
ADDRESS: S11 I.jw 39190 PERMITNUMBER: D-70S -03LC1
AM REQUESTING THAT THE ABOVE PERMIT IS
RENEWED FOR 18 MONTHS. 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 MONTHS PERIOD DURING THE RENEWAL PERIOD.
O ERBWN LDR OR CONTRAMYR SIGNATURE DATE
STATE OF FLORIDA, County of
ACKNOWLEDGED )BEFORE ME THIS
BY,O�m W eT`'e-
HAS PROVIDED
FLORIDA,
FOR OFFICE USE ONLY:
RENEWAL FEE:
_ DAY OFF 120
WHO IS PERSONALLY& TO ME , OR
t�\v/ AS IDENTIFICATION.
SEAL
No. of Open Inspections = Total No. of Inspections = (% of Open Inspections).
Original Permit Fee $ x Open Inspections (%) ' _ $ (Renewal Fee).
Example: [15 -= 23=.65(%)] $175.00(permit fee) x .65(%) _ $113.75 (Renewal Fee)
SLCPDSD REV 4/1I2011
_ •Y"; •.`,*: AOUREY B. HUMPHREY
-Y.
MY 00MMISSION q EE 061159
'd` E%PIRES: March 0, 2015
"'�.,p �;4°,° BoW d7bm Notary public Underwriters
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- SCANNED-- - _ -
BY
St. Lucie County
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