HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SzkVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578 RECEIVED
PERMIT RENEWAL REQUE T NOV 0 12018
ST. Lucie County, Porn
PERMIT NUMBER: 1903 -00-7� ADDRESS: SSO f D rahc e— AU 'C_
I, . o 5 -F—� k % • W 1 I am requesting that the above permit be renewed. I
understand thaV 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
OR
Print Name
SIGNATURE
lb 11
DATE
STATE OF FLORIDA
COUNTY OF fir-- . L,[Ae-I /o
ACKNOWWL''EDGEDII BEFORE ME THIS �1� DAY OF N O V -f VA DP e' , 20 l 0
BY :JO S ZO h • W 1 ((f Ir WHO IS PERSONALLY KNOWN TO ME V" . OR
HAS PROVIDED AS IDENTIFICATION.
STATE F FLORIDA,fi ORIDACounty of
Q
altoLy-1-1 Rgig
WESIG ATUREOFNOTARY SEAL 539082021
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=S113.75 (renewal fee)
Revised 7/21/2014