HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING' AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIOE71
2300V1RGINIAAVE - - 'FORTPIERCE, FL34982
(772)'462-1553 Yas (772) 462-15
SCANNED
BY PERMIT RENEWAL REQ
St. Lucie County
PERMIT NUMBER: 1-109.0SOLS ADDRESS: I W\O SF Q2ekLr-% , Rc>-))
I, 31L15A� n `C`r t ,I am requesting that the above permit be renewed. I
understand that I must- scli dule 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.
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O ER! CONTRACTOR SIGNATURE
Print Name
STATE OF FLORIDA
COUNTY OF SV t.�r`� o ,
t�[ Qplk%
DATE
ACKNOWLEDGED BEFORE ME THIS � DAY OF �a,n� , 20 \�
BY ll4Y[� f1—CZi�p��l WHO IS PERSONALLY KNOWN TO ME, V/- . OR
HAS PROVIDED
STATE OF FLORIDA,
FOR I E ONLY:
Number of Open Inspections: 3
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: � 5a
Original permit fee:toSO x%open= $�a5-CA Renewal fee
AS IDENTIFICATION.
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal.fee)
Revised 7212014
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EXPIRES: July 28 2019,
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