HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE =RE
FORT PIERCE, FL 34982(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUES JI
PERMIT NUMBER: 1 �! G _ G ?i �U 2-c 1 ' � IV %�i/ UI✓ �j ALL r D7Z 1 1�%
ADDRESS:
I, kA fHm /k t I—, b'rA7/2A— 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. SCANNED
Justification /Z. rL ])'t5CK Tr l�E S up/�G/ca- /S' 11 Kln G BY
St. Lucie County
OWNER/BLDR OR CONTRACTOR SIGNATURE
f r spj ll y r Z-- 65 r�z4
DATE
Zd
STATE OFFLO
COUNTY OF
ACKNOWLEDGED BEFORE ME TIES _C-e- DAY OF 14 !-A • , 20_za
BYt�,4�l 1 WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED
STATE OF
FOR OFFICE USE ONLY:
AS IDENTIFICATION.
KAREN S. NltLbtly
State of Florida-Notaq flobI
Commission # GG 20748,
My Commission Expires
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 7212014