HomeMy WebLinkAboutPERMIT RENEWAL REQUESTC.
PLANNING AND DEVELOPMENT SERVICES DEP CEIVED
Building and Code Regulations Division
2300 VIRGINIA AVE,
FORT PIERCB, FL 349a2
(772)462.1553 OCT 3 0 2017
SI;HIVIVtL
Permitting Department
PERMIT RENEWAL REQUEST St. Lucie Count FL
BY Y,
St. LUCip rni in, r c^
ADDRESS: ( !fey - . PERMIT NUMBER: ` L C 1 �U I - 1 ` .
1, G am requesting that the above permit be
renew. I understa d that I must schedule and pass all required inspections for the
permit to be fivaled. 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 IMA OF /7rc�c A(t
/0 `at `7 !/%
owN> R e ACTO0
n 5IGNAr11RE HATE
Print Name
STATE OF FLORIDA
COUNTY OF Ofr. r K 4
AC"OWLEDGED BEFORE ME THIS a7 11, DAY OF OC-6bor , Ze / 7
WHO IS PERSONALLY KNOWN TO NYE 'OR
HAS PROVIDED AS IDENTIFICATION.
STA LO ,1DA aunty of 4 w
CNATUR F Y SEAL
FOR OFFICE USE ONLY:
> NOWY pum stow orflaft
Number of Open inspections: Zack DM gf*y
ComTotal Inspecdons: %rv/ MF Toro n 20
(Divide open by total to get % of open inspections),
Percentage:
Original permit fee: ZL15,0o x % open = $ Renewal fee
Example: 115 divided by 23=.65(%)) 5I75(permit fee) x .65--$II3.75 (renewal fee)
RevInA 6/24/2014
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