HomeMy WebLinkAboutPERMIT RENEWAL REQUESTFEB-20-2018 08:48 From:
1
To:4621578 Pase:4/6
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
a
t BUILDING AND CODE REGULATIONS DIVISION
Lc7f�7 2300 VIRGINIA AVE ,A
FORT PIERCE, FL 34982 ISN /F
(772) 462-1 ii3 Fax (772) 462.1519
SCANNED
BY PERMIT RENEWAL REQUEST �Oc O
St. Lucie Countv '�A 67.
PERMIT NUMBER; 170b -06774 .. ADDRESS: S60ISPAA1t-�It�th d1wo C("6
am requesting that the above permit be renewed. I
understand that I mast 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
a -1p-1Y
D$ CONTRACTOR SIGNATURE DATE
AP.. -T4 m 4. Lam„
Print Name I-
STATE OF FLORIOA /
COUNTY OF SPLlAei o,-
ACKNOWLEDGEDBEFOREmETMS�µDAYOF Ur 211
BYC-%43 ✓A 4) 0/SPERSONALLYKNOWNTO _x .OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF-FLORIDA, County
7 ,rr,oyilDw I J S 1KA T13M1W W, SUTTON
SIGNATURFJOFNOTARY NOTARYPLISIM
STATE OF FLORIDA
CorinAFF106511
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee; X % open d S Renewal fee
Example: [15 divided by 23=.65(%)] 5175(permit fee) x.65-S113.75 (renewal fee)
— - -- Revised 7212014.