HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS.DIVISION
2300 VIRGINIAA AVE
_ FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
SCANNED PERMIT RENEWAL REQUEST
BY
St. LudeCOWtt"y
PERMIT NUMBER: 12NCJw���ADDRESS: `V V 9e( rfV �S /
CI, , r,hQ
y) yq—I -(o am requesting that.the above permit be renewed. I
understaTill that I must schedfile and pass all required inspections for the permit .to be finaled. Further, I
understand that this is a ONE TIM RENEWAL.and the pemiit shall expire should I not receive a
passing inspection during any six month period during the renewal period,.
CONTRACTOR
DATE _
STATE OF FLORIDAI^
COUNTYOF Y�)Q, ,����p `�
ACKNNO1W,,LEED�GE�D.BEFOR�EJ.METIIISD'8 DAYOF �l ITV 7f= 20�.
BY F�eQ S,0 l U� l2 WRO, IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED As IDENTIFICATION.
STATE F RIDA,; o atyof� dD
SIG ATURE OF NOT Y
FOR OFFICE USE ONLY:
Notary Public.. State of Florida
Commission_# GG 017851
My Comm. Expires Avert. 2020
:Number of O et�a,Inspectiens;_ =—
Revised[7/2142014 "" "�Total Inspections: ARRZA`-NUNEZ(Divide open by total to get % of openinspectionS) ublic State of Florida.Percentage ission M GG 017851 Expires Aug 2 2020Original permit fee: s % open $ Renewal fee ough National Notary Assn
Example: [15 divided by D=.65(%)I $175(permit fee) x .65=SI 13.75 (renewal fee)
Revised 7/'1172014