HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPERMIT NUMBER:
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
SCANNED
PERMIT RENEWAL REQUEST BY
St. Lucie County
PJS y77 ADDRESS: 7 b I 14AIZr /ZOY�1O
I, K42 i N 6 FIZ z.9 Tg- , 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
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF S! Luci 2
ACKNOWLEDGED BEFORE ME THIS $1-4- DAY OF QCG,041b 4"— , 2017
BY &e a neA A•4-4�7g ✓K . WHO IS PERSONALLY KNO TO ME
HAS PROVIDED
IDENTIFICATION.
STAOCF FLORIDA, County of .S%. /,y�fi �V JEANNE K MATTINO
�j� •e My COMMISSION # GG098938
SI A URE OF NOTARY SEAL EXPIRES May 28, 2021
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(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014