HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE RE AVE ��� D
2300 VII2GINIA MA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
NOV 13 20W
SCANNED
BY
St. Lucie Connt,
PERMIT RENEWAL REIS
perTmitting Department
St. Lucie County, FL
PERMIT NUMBER-=/G/0-0350 ADDRESS: �90��„r CX�d, A_W612L%l6111'1_
I, Z�",z lira /" . 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 ... !// /;._. / r— ,,
OR CONTRACTOR SIGNATURE
4 �'
Print Name
STATE OF FL DA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF O`I
ATE
20"
BY WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED AS IDENTIFICATION.
ESTATE OF FLORIDA, Countyof lJ �r • L V C \ 4
SIGNATURE OF NOTARY
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
DEANNA MARIE GIVENS
MY COMMISSION tt GG 022023
§MES: December 16, 2020
Bonded Thm Notary Public Undenvdtam
Example: [15 divided by 23=.65(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014 .