HomeMy WebLinkAboutPERMIT RENEWAL REQUESTT
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2306 VIRGINIA AVE
22 27 FORT PIERCE, FL 34982
(772) 462-1553 Fax (772)462-1578 SCANNED
BY
t(}UnOJAS nl 'IS PERMIT RENEWAL REQUEST St. Lucie County
a3NNVOS
PERMITNUMBER: 146P -:OGH8 ADDRESS: 2_Gq,y,r�4�oa 1✓A•t st_OG
1, �/LEfI' �[/r G/R�1j am re juesting that the above permit be renewed. I
unders d that I must schedule apd.pass all required insppections 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 during3he. renewal period.
Justification
SIGNATURE DATE
���f/GG/ffLl't'f
Print Name
K�
STATE OFi:69Rd" =rlclll'Cu"1a
COUNTYOF MO-rilOYI _
ACKNOWLEDGED BEFORE ME THIS I31:1L DAY OF AoriI .20 lg
By �Bre A+ W 1 MOLm$ WHO IS PERSONALLY KNOWN TO ME . OR
.HAS PROVIDED
SIGNATURE
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 = $ Renewal fee
S
Example: [IS divided by23=.65(%)l$175(pemiltfee) x.65=$113.75(renewal fee)
Revised W=014
APR 13 ?018
Permitting
Lucie
Countmeat
Y. FL