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
RECEIVED
11RIT RENEgL4kWIT - AUG 0 2 2018
BY =10 CountY, Permitting
St. Lucie CoUntY sT
PERMITNUMBER: SLC )'705--439a ADDRESS : I s--,0ceAz7 &- J�i a!�ZC7
I, A)Aq� 4 , 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 TIM RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
6 Ile
OV*rNER/BLDR OR CONTRACTOR SIGNATURE DATE
Rokez-4 62�z4
Print Narne
STATE OF FLIM L
COUNTYOF
ACKNOWLEDGED BEFORE ME TIHS DAY OFT
Uj� 20—JL
BY WHO lq�&ONALLY ZKNO:WN TO OR
HAS PROVIDED ENTIFICAT[ON.
M M EG AN A IR
H C'� 0
Co
EGHAN A CLAIR
My MMISSION F 9 7264
STATE 0 N County of
My COMMISSION FF907264
EXPIRES August 05, 2019
SIGNAfUR �Y
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(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014