HomeMy WebLinkAboutPERMIT RENEWAL REQUESTFEB-20-2018 08:46 From: To:462157e Paee:2�6
PLANNING AND DEVELOPMENT SERVICES I
o sib° BUILDING AND CODE REGULATIONS DP 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1.553 Fax(772)462-1578
SCANNED PERMIT RENEWAL REQUEST
BY
St. Lucie County
PERMITNUMBfiR: l?06-0077.. ...._ ADDRESS: Wj'� 142-01 LIT ad?Of 047 \
rj� t ,L6S a2 o-
I. Gh 0A SKo —,am requesting that the above permit be renewed. I
understand that I must schedule and p9ss ail required inspections for the permit to be fmaled. 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
0WNhft1 RAcrOItSIGNATURE '
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Print Name 47
STATE OF FLOItI
COIJMI'Y L•vkry e-
a- /?- Irr
DATE
ACKNOWLEI)GtDRFPOREMETHIS�AAVOFLttlAY 20
ny ckTis4p r '' iO IS PERSONALLY KNOWNT OR
HAS PROVIDER
_. .. _ AS MENTIF7CATION.
STATE OFIFLORIDA, County ofS+-LuCtq
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W'SuTTCH
NOTARY F FLOR
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SIGNATURE.f�r NOTARY
potutMFF101611
Et�irm 9r20/1018
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:____
arJ 4d
(Divide open by total to get °% of open inspections)
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T!
..
Original permit fee: x %open = $
C -
Renewal fee
Example: [15 divided by 23=.65(%)] $175(permil fee) x ,65=$113.75 (renewal fee)
Revised 7121rl014