HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
2300 VIRGINIA AVE.
FORT PIERCE, FL 34982
(7721462-1553
PERMIT RENEWAL REQUEST
ADDRESS: 3876Al 41A UNIT 70,E PERMIT NUMBER:
SCANNED
BY
St. Lucie County
1712 - o a 51'K
I,` I W&i,AS 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.
Justification FFINAL /NSAt:G70N Alp? COrxpLASi'-C—
O WNER/BLDR OR CONTRACTOR SIGNATURE DATE
�ourc.4S A •��SS�/!
Print Name
STATEOFO7 Minn-c4-
e
COUNTY
ACKNOWLEDGED BEFORE ME THIS 264'�' DAY OF 6 c-fo b et- 2019
BY b6t4q kS A R MS Se ll WHO IS PERSONALLY KNOWN TO ME Ye OR
HAS PROVIDED AS IDENTIFT CATION.
Hinnesoia
ST TE I' De>c, County of F(a nne ,� n CY=C�A�=NC SIGTURF ARY Issl
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
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 6/24/2014 /
VA