HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES
• BUILDING AND CODE REGULATIONS DI
2300 VIRGINIA AVE
FORT PIERCE, FL 34992 —
(772) 462-1553 Fax (772)462-1578
SCANNED
BY
St. Lucie County
PERMIT NUMBER: 1711-0556
PERMIT RENEWAL
ADDREss: 7632S US HWY1
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AUG 0 9 2018
ST. Luelc
I, EDWARD LOUDERBACK , am requesting that the above permit be renewed. I
understand that I must schedule and pass allrequired 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 OVERLOOKED CALLING THE INSPECTIONS WAS AT THE BOTTOM OF FOLDERS
8109118
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
EDWARDLOUDERBACK
Print Name
STATE OF FLORID
COUNTYOF } c.
ACICNOWLEDGED BEFORE ME THIS DAY OF —A" Ljs i 20_LR
BY n rr1 Ljc.0 ,il eyi,pc, i t_ wHO Is PERSONALLY KNOWN TO ME ✓
,OR
HAS PROVIDED
AS IDENTIFICATION.
STA7EPF FLORID.4,
RNotary PubAc State cl Flvdda
F4ietlne LLoWetbeck My Com =Ge 10%10
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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 = �r1,�enewal fee
Example: (15 divided by 23=.65(e/u)1 8175(permit fee) x .65=SI13,75 (renewal feel
Revised 721/2014
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