HomeMy WebLinkAboutPERMIT RENEWAL REQUESTc
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
BUILDING AND CODE REGULATIONS DIVISION
, 2300 VHtGIlVIAAVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
SCANNED PERNIIT RENEWAL REQt:RECEIVED
3 0 2019 .BY
St. Lucie�Cloun7ty 1 2Qunty, Permitting
PERMITNUMBER:7/oZ—V S 7 ADDRESS:/J9 �() -rALYU kdd ,-
I, &4 - R I-,iGe am requesting that the above permit be renewed. I
understand that I m st schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TEVIE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification Work t c (binnleJ . IA/RA.., 6A Cvt<'n�o !
/ -A?- /7
VATURE DATE
L Ic
�Gswla e ✓
Print'Name
STATE OF FLORIDA
COUNTY OF d� ,E
ACKNOWLEDGED BEFORE ME THIS Ut� DAY OF �" "r I , 201f-
1
BY Qoe u wt.�✓ WHO IS PERSONALLY KNOWN TOMEOR
HAS PROVIDED
STATE OF FLORIDA, County of o rwwa y,
GNAT[{$ O OTARY
AS IDENTIFICATION.
Notary Public State of Flcdda
SEAL g Zack Daughtry
MY `EXPIM3100212oSSim 20 034903
►a F60
FOR OFFICE USE ONLY: 3as Ob
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(%)l $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7l2 MO14