HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST SCANNED
BY
. (� 5 / St. Lucie
PERMIT NUMBER: )qV r- V (0 )S ADDRESS: a/y % 3 /�-�"P� p
I, , 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 Ix nth period during the renewal period. /
Justification
cp. g
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF f
ACKNOWLEDGED BEFORE ME THIS � DAY OF
BY WW \(:kU- WHO IS PERSONALLY KNOWN T ME OR
HAS PROVIDED U AS IDENTIFICATION.
SEAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections) '
Percentage: / O
Original permit fee: x % open = $ Renewal fee v
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (
Revised 7/21/2014
ED
FEB 18 2020
Permitting Uepartment
St. Lucie County,`_