HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGE41A AVE
FORT PIERCE, FL34982
(772) 462-1553 Fax (772) 462-1578
6LHNNED PERMIT RENEWAL REQUEST
BY
St. Lucie Cou
n
ty
P+E-RRMIIT"NUNMEE%R: `ADDRESS: /0600 S0[P14hD 5fv1sO�QP4cLI
I, !�!/l� --/� / am requesting that the above permit be renewed. I
understand th 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
OWNER/BL OR CONTRACTOR SIGNATURE DATE
/M/(ti p c��&4to
Print Name
STATE OF FLORIDA
COUNTY OF
Y SL-
..
ACK}N��O��WLEDGED BEFORE TES OF
20
(MEN
� h i1D�A�Y
BYY'/)WA�L c�)C.IJ LJ914110ISPERSONALLY KNOWN TOME.
OR
HAS PROVIDED�a • . (,{/)' ' �l r AS IDENTIFICATION.
STA OF FLORIDUA, County of
AUDREY B. HUMPHREY
v: r MY COMMISSION S FF 174772
SI TURE OF NOWY SEAL.
+�r EXPIRES: March 6, 2019
.
"�Rf�., •, Banded Thm Notary Pubrw undemaen
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x °/aspen = $ Renewal fee
Example: [15 divided by 23=.65(%)l $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014