HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
230O VrttOM AVE
FORT PIERCE, FL 34982
(772)462-IM3 Fax(M)462-157s
SCANNED
PERMIT RENEWAL REQUEST BY
St. Lucie Countv
C
PERMIT NUMBER: I�LM'! 17�5 ADDRESS:3004 W0 oC�•-s(-.)ftkL� .
1, am requesting that the above permit be. renewed. I
understandmust schedule and pass all required inspeobous for the permit to be finaled. klirther, I
understand that this is a and the permit shall expire should I not receive a
passing inspection goring any six month period during the renewal.perlod.
Justification
O WNERIBLDR PA CONTRACTOR SIGNATURE DATE
C (Y\i Ly l Dk 0...
Print Name
STATE OF PLO A q
7 T'
ACKNOWLEDGED BEFORE ME THIS ZI$ DAY or
BY &Ny : L ., �y r �1.� WHO IS PERSONALLY KNOWN TO M8 .OR
HAS PROVIDED
AS IDENTIFICATION,
STATTI OFPLORIDA, Comty of 12)r-e - "
7 riwsg
YMEPRE9562>6S! URE OP NOT SEAL ri EXPIRES:Me 31,2020 BOMAdThn, u,a..�n.eo•....,-_.. i
FOR OFFICE USE ONLY.
Number of Open InspccGons:
Total'"
(Divide open by total to get Yo of open ]nspectionx) '
Percentage bb
Original permit feat x % upon = $ 'I_Renewal fee
Example; '({$ divided by 23-WS(%)l $W(permit fee) x ,65A$113.75 (renewal foe)
Revised7/21014
JUN 21 2018
Permitting Department
St. Lucie County, FL
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