HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
i300 WRGINIA AVE
FORT PIERCE, FL34982 SCHNNt�
(772) 462-1553 Fax (772) 462-1578
BY
PERMIT RENEWAL REQUEST St. Lucie Cn11r•
PERMIT NU BER: t; L U ADDRESS: /�t I l \/t/LY
�L(/if% / am requesting that the above permit be renewed. I
under tand 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 /� �%_ di-j /V2V/Gi/<!_��f�Tlr94 J %b
(^ FR�/BBLD��tRR OR COS ACTOR SIGNATURE TURF TE
Print Nam
STATE OF FLORID
COUNTY OF wCi.Ci
ACKNOWLEDGED BEFORE METHIS 1 V DAY OF .20
COMEOR
AS IDENTIFICATION.
91 f rvga= Al10REYB.HUMPHREY
•, .- W COMMISSION 9 FF 174712
S g•. EXPIRES: March 6, 2019
•�Rf,Fb Bonded Thry waryPobrcUnderanters
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
____ Original_permitfee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014
FEB 14 2018