HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
i300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 SCANNED
BY
St. Lucie County
PERMIT RENEWAL REQUEST
PERMITNUMBER: 6� D - 0-�3 7 ADDRESS: /6)(500 Oca r-' T)a- 67� C-
I,_'j p fj/ , am requesting that the above permit be renewed. I
understand this 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
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OWNER/BLDROR�T(' SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS ) DAY OF,j) C- C , 2017—
BY cis% l` WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED �� �J �' 1-JAS IDENTIFICATION.
STATE,QV FLORIDA, County of D4
hiY cOM69S5i0N d"FF 174772
SIGNATURE OF NOTA SEAL; °� h,' EXPIRES: March 6, 2019
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Banded Thm Wt,7 PA1. L' dzmrlers
FOR OFFICE USE ONLY:
Number of Open. Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x e/o open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212014 _ RECr— We
I E
DEC 11 2017