HomeMy WebLinkAboutPERMIT RENEWAL REQUEST03102/2018 15:23 (FAX) P.0011002
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT 1 BUILDING AND CODE REGULATIONS DIVISION
2308 VIRGIMA AVE I'
FORT PIERCE, FL 34982
SI;HNIVELI (772)462-1553 Fax(772) 4624578
BY :RECEVED
AR 0 5 2018
St. Lucie County PERMIT' RENEWAL REQUEST e county, Permit+inn
SLC 14 10--0045- Z014 SE pi-s¢ Lve'te
PERMIT NUMBER ADDRESS:
Wi�l�c�yy► T• �c�ellberse'r-
1, 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 eriod during the renewal period. %
justification Cn%A C-4-C r hlA ep, / A v i-r nA n
03 0
O�W/NERIB.LDR OR CO TRACTOR SIGNATURE DATE
Print Name
STATE OF FIA D—
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS
CO-
DAY OF V ' "Q
, 20A6_
EY
IS PERSONALLY KNOtVN TO
, OR
lQ_ MITIVA1� a
AS IDENTIFICATION.
STA1 OF FLORIDA, County of Q6
ICEALY ]0 CASH
VA IF)!
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SIGNATURE of NOTAR SEAL In=°r 2or9
FOR OFFICE USE ONLY:
Number of Open Inspections:
ij—
Total Inspections: '15
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: ° x % open = S � 06 Renewal fee
Example: [15divided by23=.65(%))$175(permitfee)x.65=$i13.75(renewal feo)
Revised 7121t2014