HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
c BUILDING AND CODE REGULATIONS DIVISION
COUNTY
2300 VIRGE41A AVE
FORT PIERCE, FL 34982 -
(772)462-1553 Fax (772) 462-1578 RECEIV5D
PERMIT RENEWAL REQUEST DEC 1 1 2019
SCANNED ST.. Lucie County, Permitting
BY
PERMIT NUMBER: ADDRESS:
1904-0495 6777 TucaPSPcie County
1 Rebecca J. Mays , 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 Need to obtain final inspection
�f1.0W1 �1--
OWNERBL R OR CONtRACTOR SIGNATURE
T
Mal
Print Name
STATE OF FLORIDA
COUNTY OF P ",\ -S
ACKNOWLEDGED BEFORE ME THIS 16 DAY OF
(aI l6sa o(9
DATE
20/9
BY _Re - lest �. (Ykc"-($ WHO IS PERSONALLY KNOWN TO NE OR
HAS PROVIDED AS IDENTIFICATION.
ya10 Notary Public State of Florida
r° �": Anne Hillhouse
My Commission GG 139059
SEAT. Q?) Expires 11/0412021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: 00
Original permit fee: x % open = $ Renewal fee
Example: [15 divided by 23=.65(°%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014