HomeMy WebLinkAboutPERMIT RENEWAL REQUEST_ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
�- BUILDING AND CODE REGULATIONS DIVISION
• ` ' _' 2300 VIRCINIAAVE SCANNED
FORT PIERCE, FL J49S2 BY
(772) "2-15S3 Fax (772) 462-I57S
St. Lucie County
PERMIT RENEWAL REQUEST
PERMITNUMBER: 009- "c& ADDRESS: •9402 dUA&l'/0.44014'1 Rcu4 H
1, it 6TI [ii71 t/mac am requesting that the above permit be renewed. I
understand that I must schedute and pass all required inspections for-the�permrt to 6e finaled. Further, l
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six'inonth period,Kiing the renewal period.,
Justification
y//s/8
DATE
Print Name
STATE'OF-F69R}Brk ?t-,d;M0.
COUNTYOF IY1tjcL0YI �M /1� 20 l$
ACKNOWLEDGED .BEFORE ME THIS ��+ DAY Or AC(1 -
BY �Ye'l`l' W i Ili ams
. WHO IS PE[tSC:NALI,Y KNOWN TO ME V1 OR
FOR OFFICE USE ONLY:
Number of Open Inspections:—
Total Inspections:
(Divide open by total to get % Of open inspections)
Percentage: �, Renewal fee
Original permit fee: /o x open = $ .
Example: [15 divided .by 23=.65(e/?)] $175(pennit fee) x .65=$I13.75 (renewal fee)
Revised 7212014
RECEIVE®
APR 13 2013
Permitting
St. Lucie
Department
COunty, FL