HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 .r
(772) 462-1553 Fax (772) 462-1578
SCANNED JUN 2 0 2017
BY PERMIT RENEWAL REQUEST St. Lucie County pel3rnn rlNcSt. Lucie County, FL
PERmrrNumBFRIpy- "g(j�}"1� ADDRESS: jtttn011Ce Cryc PIQ7rA Mtle 1ti4
I, LQ (Y U LI Q a (0y 1 am requesting that the above permit be renewed. I
understand t at 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 ProtPei- OornplM-e rinaA I>1Sjoee—on Oeeded
l9I 11
DATE
Print Name
STATE OF FLORIDA
COUNTY OF SF . LIA P L e
ACKNOWLEDGED BEFORE ME THIS 19 DAY OF A LLI) e. , 20 —Aa_
BY LQ r Y U .I L` (LQi'y t WHO IS PERSONALLY KNOWN TOME �O , OR
HAS PROVIDED _ _ AS IDENTIFICATION.
STATE OF FLORIDA, County of
.A. _ „
FOR OFFICE USE ONLY:
ALICIA HERNANOEZ_°°<:
a °°•.
Notary Public - Statebl Florida
• Commission # FF 898635
=�.r p My ComhAF. tires Jul 13, 2019
UP Bonded Bonded through National Notary Assn.
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 7/212014