HomeMy WebLinkAboutPERMIT RENEWAL REQUEST11
a
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
SCANNED
PERMIT RENEWAL REQUEST BY
St. Lucie County
PERMITNUMBER: / 9 0.-�-010ADDRESS: i7�^" -— ' 9
am requesting that the above permit be renewed. 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 month period during the renewal period.
Justification
b
OWNERBLDR OR Cq&%ACTOR SIGNATURE
Print Name
ATE
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME TBIS p I D�A/Y %'� OF t / e� . . 20
BY n7`ti//VI1H0IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED A • /'- • c Lint . AS IDENTIFICATION.
STATE OF
A MPRREY
MY COMMISSIONS GG 300817
EXPIRES: March 6, 2023
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 7/212014
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