HomeMy WebLinkAboutPERMIT RENEWAL REQUESTI
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
% BUILDING AND CODE REGULATIONS DIVISION
•
2300 VII2GINIA AVE
-_-- ----- - --- FORT PIERCE, FL 34982 RECEIVED
(772) 462-1553 Fax (772)462-1578
lUN 1. 9 2018
S(;HIVNELf rmittin
BY PERMIT RENEWAL REQUEST Permitting
tub Department
St. Lucie Countv
cle county
PERMIT NUMBER: llkJ4 -0,37� ADDRESS: 94A.� S 6
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 ffnaled. 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
. )g,— \S . 20\(A
DATE
Print Name
STATE OF FLORIDA
COUNTY OF St- f_VtJ't
ACKNOWLEDGED BEFORE ME THIS DAY OF -1-On -e 9_
, 20_L
BY LETS /� d `' (ZO"S WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED T) L AS IDENTIFICATION.
STATE OF FLORIDA, County of .Sr Gdc rZHEATHER BURFORD
.State of Florida -Notary Public
A ,; Commission a GG 183217
S OF NOTARY SEAL M C I � y om 11631on Expires
February 06. 2022
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 7212014