HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
1 BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
SCANNED BY PERMIT RENEWAL REQ RECEI
ST VED
St. Lucie County JAN 3 0 2019
PERMIT NUMBER: / 01 - D E6
'57i
Lucie
I'9'14 rk ' L--�N am requesting that the above permit be renewed. I
understand that I mu4t 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
CONTRACTOR SIGNATURE
r
Print Dame
> a9-//
DATE
STATE OF FLORIDA
COUNTY OF jn�r, \\
ACKNOWLEDGED BEFORE ME THIS O7DAY OF VG.nk r L , 20—/1—
BYZM t ,, k5kr / WHO IS PERSONALLY KNOWN TO ME OR
i
HAS PROVIDED
AS IDENTIFICATION.
STATE OF FLORIDA, County of r/lkst �
� f�f]�� �a/Mk� Notary Public State of Florida
Zack Daughtry
A t4 ON A
GNA NOTARY SEAL g • My Commission GG 034963
` "d Expires 10/02/2020
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(°/u)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014 'i 'l Y ,U V