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 SCANNED
BY
PERMIT RENEWAL REQUEST St. Lucie County
PERMITNUMBER: /566-O6341 ADDRESS: 907d 004e-'C
I, /%%/�/�i '-V //- ��/�/�� , 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 `VA -SW 7 ya/Si/l�jG—�
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
fyJ• f/ /�i,y/lk;'z
Print Name
STATE OF FLORIDA
COUNTY OF —S% 2pe l E
ACKNOWLEDGED BEFORE f,.411 THIS DAY OF 42� 20JE
1]1
HAS PROVIDED
FOR OFFICE USE ONLY:
WHO IS PERSONALLY KNOWN TO ME , OR
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
AS IDENTIFICATION.
��„ ANGELA M HUFF
�� , , �; Notary Public -State of Florida
' ` ' Commission # FF 234730
SE -%+�, oo°c` My Comm. Expires May 27, 2019
9L,`„•'• Bonded thrcugh National Notary Assn.
Example: 115 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212014