HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
COUNTY A�
2300VIItGINIAAVE
RECEIVED
= FORT PIERCE, FL34982
(772) 462-1553 Faz (772) 462-1578
SCANNED PERMIT RENEWAL REQ ST NOV - s 2018
BY Permitting Department
St. LucieCOuntY St. Lucie County, FL
PERMUNUMBER ®— 01 / ADDRESS: 20G�
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 t4i, s is a ONE. THE RENEWAL and the permit shall expire should I not receive a
-passing inspectioh during any six month period during the renewal period.
Justification Ir1i"14rVCr,_)L S4 I-/eot-TA
SIGNATURE �� DATE
BACajd
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS v ' DAY OF
BY 20!2e2 /. , &CaiU WHO IS PERSONALLY KNOWN TOME_ "+ OR
HAS PROVIDED .
AS IDENTIFICATION.
DEBORAHRAE00t8t W
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CommlstbniG0113'29i
SEAL
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E>�6asJwe15,2021
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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/a)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014 -
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