HomeMy WebLinkAboutPERMIT RENEWALPLANNING 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 AUG 0 2 ?,n.18
SCANNED S1 Lucie County, Permitting
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PERMIT NUMBER: 5 Lc- M45�0395ADDRE89: HWO laccv) �141— n3 �
1, :� /—, k- 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 six month period during the renewal period
Justification
OWNER/BLDR OR CONTRACTOR SIGNATURE
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DATE
STATE OF FLO D
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COUNTY OF V M ECACL
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ACKNOWLEDGED BEFORE ME THIS SODAYOF JIII�J 20—LC
BY Zbef+ &t,-*,rk- WHO is PEQ���O ME OR
HAS PROVIDED S IDENTIFICATION
S A, County of Ml N A
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I nENS A 105 19
-My EXPIRES August 05, 2019
SIGNATURE OF NO .20
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 7/2112014