HomeMy WebLinkAboutPERMIT RENEWAL REQUESTa . .
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578 SCANNED
BY
PERMIT RENEWAL REQUEST St Lucie Countv
PERMITNUMBER: ISD200Cq ADDRESS: N U5 ]W`( Ct;
I lJ J-VS f silb 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 [k) li t" '6-' l T f O2 k -a2e R -GJUVN
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS I� DAY OF • 20
BY;p,� —� ■ WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED
AS IDENTIFICATION.
CZA
ST E OF FLORIDA, County of
LABHANNA INle 2
e Notary Public - Silas of Florid
6a
A RE OF NO "I ARY SEAL 'a a w. • a My Comm. Expires Cec 0, 2018
• 'o`; Commission # FF 177249
'�•�tFOi .Rep
Banded through National Notary Assn.
a-.-rv�e-o.•3'2.--------
FOR OFFICE USE ONLY:
Number of Open Ins ections:q
Total Inspections: l.-
(Divide open by total to get % of open inspections)
Percentage: () A& z QD
Original permit fee: x % open = $a3a" Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34952
(772)462-1553 Fax (772)462-1575 SCANNED
BY
St. Lucie County
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1 `J O 2 - O0q Ci ADDRESS: (o 251 N . 1iW,4 0
I, (I .tJ r 1rS MeA r li10 / mA l I (a 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
y 1
1b
STATE OF FLORIDA
COUNTY OF Sk}wrs.
ACKNOWLEDGED BEFORE ME TMS I i DAY OF L'{�&Mja,—
HAS PROVIDED 1 n
STATE OF FLORIDA,
FOR OFFICE USE ONLY:
DATE
WHO IS PERSONALLY KNOWN TO ME . OR
Number of Open Inspect''�1pp ns: 1
Total Inspections:
(Divide open by to[ to get % of open inspections)
Percentage: Lf-
Original permit fee: S• oex % open = $ /03. Renewal fee
AS
pool,
INGRAM
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o=;
�ASHAHNA
Notary Public - State of Florida
: e
My Comm. Expires Dec 20, 2018
ape;
Commission # FF 177249
m'
Bonded through National Notary Assn. l
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212014