HomeMy WebLinkAboutPERMIT RENEWALCi
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
- 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
GD (772) 462-1553 Fax (772) 462-157 RECEIVED
N
�`UCeGOU�hi PERMIT RENEWAL REQ ST APR 2 6 2018
ST. Lucie County, Permitting
PERMIT NUMBER: I- �M - CCY'- I ADDRESS: 41 On L3 -f)An— 't 32
),M iCK)nd :H 1 , am requesting that the above permit be renewed. I
understand that I must schedule and pass 11 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 f o Mca c Yam? lr C'k X± CE -tnv ' A-A1�Q
OR
Print Name
STATE OF FI,QRiDA� G C
COUNTY OF
DATE
ACKNOWLEDGED BEFORE ME THIS 4�2-a DAY OFT)f
BY M1 CY-UeI�SPYIbe-I4VHO 1S PERSONALLY KNOWN TO ME J/ . OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA- County of �T La U C'.t -C SNtfj9l'b
ne:egn Short
NOTARYPUBLIC
IGNATURE NOTASTATE OF FLORIDA
Comm#GG148342
Expires5125I2021
FOR OFFICE USE ONLY:
Number of Open Inspections: _ -
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x °/u open = S Renewal fee
Example: (15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212014