HomeMy WebLinkAboutPERMIT RENEWAL REQUEST10/17/2017 6:00:36 AM PST (GMT-8).r- ,M: 8138672050-TO: 177.246ZA.-5-7.8 t Page:
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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
BY PERMIT RENEWAL REQUEST
St. Lucie Countt-
PERMIT NUMBER:. 14 ADDRESS: �a /d11 • g/p�pL'e
am requesting that the above permit be renewed. 1
understand that I must schedule and pass all required inspections for the permit to be finaled. Further,
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspectionduringany six month period during the renewal period. �B�
Justification �2 •�/ e- )Olaw 64 �PlA,��Y",0' /ero `" 01
OWNF.R/RLDR OR .ON� T A_CT'OR SIGNATCRE
Print Name C
STATE OF FEFRH3A K od h (~ P o hnoL
COUNTYOF 6UnC0 lbV
f® /7//'
DATE
ACKNOWLEDGED BEFORE ME THIS i 1-b DAY OF (*I tL __ , 20 0
BY 'DI I Ia W' L WHO IS PERSONALLY KNOWN TO ME V , OR
HAS PROVIDED AS IDENTIFICATION.
Nool CaRoilat �5tir><omba�
STA E OF FL-GR+BA. County of
Lq11 n ''��]]}}Nt -- T No ary6Publla n
`"+(k 0 .�1�, IN Buncombe County
SIGNATURE OF NOTARY SE North Carolina
M Commission Ex Tres 510 2079
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 = S Renewal fee
Example: [15 divided by 23=.65(9%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
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OCT 17 2017