HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE SCANNED
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578 BY
St. Lucie Countv
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1 �I 03 ZDRESS: / 9 60 J O(e4h IJ 1 Se hS O'7
I, � I r I-, A 2 See II4 ' 0 , 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 duritig any Muth period during the renewal period.
Justification
ize
Print Name
STATE OF FLORID
COUNTY OF.✓
F
ACKNOWLEDGED BEFORE ME TIES �
HAS
it
STA r • FLORIDA,
DATE
OF 20L(0--
IS PERSONALLY KNOWN TOME OR
AS IDENTIFICATION.
FOR OFFICE USE ONLY:
Number of Open Inspections: _ •;iP')ry�4 Al10HEY8. RUMPHREY
Total Inspections: F•i +a MY COMMISSION a FF 17472
(Divide open by total to get % of open inspections)''., EXPIRES: March 6, 2019
M,1'a• 6ended TAm" Pubs: urdeiwaers
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 7212014
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