HomeMy WebLinkAboutPERMIT RENEWAL REQUESTNOMWOR PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578 :RECEIVED:SCANNEDBY PERbIIT RENEWAL REQUEST 3 0 P0St. Lucie CountyST. Luounty, peng
PERMITNUMBER:IW7 —Q (Z ADDRESS: $(( r' `K Psidt YIiV�
r
I,e/t�e ✓ , am requesting that the above permit be renewed. I
understand that I muA 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. l
Justification Wnr OftQQ ! l a, m� o ��k,,d ( 1) iC r
SIGNATURE
C
�-a9�19
DATE
STATE OF FLORIDA
COUNTY OF df-cigi „_
ACKNOWLEDGED BEFORE ME THIS a 7 /� DAY OF 34t n•4r d , 20—d—
BYlS,tayy' 1= K WHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA,of
Notary Public Stets of Florida
Zack Daughtry
SrGNATT,W 9rNOTARY SEAL g �; My Commission GG 034967
quo Dome 10=2020
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 7212014