HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
Z300 VIRGINIA AVE
FORT PIERCE, FL34982
(772) 462-1553 Fax(M)41578 SCANNc®
BY
St Lucie CmInht
PERMIT RENEWAL REQUEST
17,0s- veN�
PERMIT NUMBER: ADDRESS: %/ M I `14 EL
I 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 10 P::� 7 dv A t-- ! P< rea76—'� A-
WNERIBLDR OR CONTRACTOR SI NATURE DAA
m Print Name
_
STATE OF FLORI tj
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS N DAY OF . 20 /
BY
HAS PROVIDED
STATE OF RIDA, County (
y
SIGNATURE OF NOTARY
FOR OFFICE USE ONLY:
IS PERSONALLY KNOWN TO ME OR
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x %open = $ Renewal fee
AS
111
Example:[15divided by23=.65(°/o)]$175(permitfee) x.65=$113.75(renewal fee)
Revised 7212014
FEB 14 2018