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 RECEIVED
SCANNED
BY
St. Lucle County
PERMITNUMBER: e�-O(b1 L
PERMIT RENEWAL REQUEST FEB 13 2019
ST. Lucie County, Permitting
ADDRESS: 1531 S LLS � TOI A 2 l..t-• k -IFL, 3"5D-
I, fW VlG A V ob a 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.
e --- if 14-� W 13��oIG
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Lib n1foefli
Print Name
STATE OF FLOPRA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF T:;'76ruo-f , 20�
BY LU ke M 16L - WHO IS PERSONALLY KNOWN TO ME L,-�, OR
HAS PROVIDED
AS IDENTIFICATION.
Loplis" NYDER
LgY COMMISSION S GG 22W5
=�•+te: EXPIRES: October17,2022
���.aaiiM1^�.• BW0A7tWN0ta1VPubkUW0r*ft s
FOR OFFICE USE ONLY: r 1
Number of Open Inspections:Total _ �o
(Divide Inspections:
(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