HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (712) 462-1578
SCANNED
PERMIT RENEWAL REQUEST BY
St. Lucie Cow
PERMITNUMBER: 14 O`T— O11CJ ADDRESS: 75T0— 3-3136 S ®xa4n) tY`�
I, �l t� - �st� 1 , am requesting that the above permit be renewed. I
understand that ust 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. I
OWNERBLD CO RSIGNATURE DATE
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Print Name
STATE OF FLORIDA lz // '
COUNTY OF ..•..iii����"'��,_
ACKNOWLEDGED BEFORE ME THIS �_ DAY OF C , 201 %
By 9a "l"8�ylrj I WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED -Y� w o R n AS IDENTIFICATION.
FLORIDA, County of
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FOR OFFICE USE ONLY: yn( n
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(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014
DEC 11 2017