HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMEN '
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 ;� T C {�
(772) 462-1553 Fax (772) 462-1578 11 em lz,;. �;�. e6 ;
6GANNED
BY
St. Lucie County
PERMIT NUMBER: 1703-0613
PERMIT RENEWAL REQUEST DEC 1 4 2017
PERMITTING
St. Lucie County, FL
ADDRESS: 2925 Juanita Avenue, Ft. Pierce, FL
I Charles D. Kerns 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 monthperiod during the renewal period.
Justification Weather and right of way permitting delays
December 11, 2017
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Charles D. Kerns
Print Name
STATE OF FLORIDA
COUNTY OF s W LUGS
ACKNOWLEDGED BEFORE ME THIS 11th
By CHARLES D. KERNS
HAS PROVIDED
DAY OF December 2017
WHO IS PERSONALLY KNOWN TO ME /, OR
STATE OF FLORIDA, County of L4 i r a V
SS NAI,�NOTARY
FOR OFFICE USE ONLY:
AS IDENTIFICATION.
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Meal obbitls
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4w> Expboa 03116=21
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(0/o)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 721/2014