HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
SCANNED PERMIT RENEWAL REQUEST
BY
St. Lucie County
PERMITNUMBER: I WC—GZTS ADDRESS: I CIIS W l/i l ii Y
I
I, J ti r'ZFti am requesting that the above permit be renewed. I
understand 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 Ve 4,r/ ✓cu; s i k; + h2 Ig1G n -i-r, U Sc E x;5,1,'t4 S%b A hii
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OWN L CONTRACTOR SIGNATURE
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Print Name
1/i21 /!7
DATE
STATE OF FLO
COUNTYOF D if
ACKNOWLEDGED BEFORE ME THIS DAYOF 20—ff—
BY WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED -1— l _ i _ , AS IDENTIFICATION.
STATE OF
SEAL
FOR OFFICE USE ONLY: KAREN S. NIELSEN
i
e° �n's State of Florida -Notary Publi
Number of0 en Inspections: = Commission # GG 207484
P P ,� My Commission Expires
Total Inspections:"O;�`��YY June 12, 2022
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212014