HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
e BUILDING AND CODE REGULATIONS DIVISION
. 2300 VIRGINIA AVE
FORT PIERCE, FL 34952
(772)462-1553 Fax (772)462-1575 RECEIVED
SCANNED PERMIT RENEWAL REQUES JAN 3 0 2919
BY
St. Lucie County Sr, wele 6ealnty, PermIgIn9
PERMITNUMBER: /0�O/%i-7ADDRESS: A5�50 M,&U It AC/ &A
am requesting that the above permit be renewed. I
understand 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 Woe k- i !; COA.01ti Ec 1,M ..ia4 or enat'n+ r' h i1 g(
J
DATE
Ah anr,'
Print flame
STATE OF FLORIDA
COUNTY OF Orew�r
ACKNOWLEDGED BEFORE ME THIS P l 17^ DAY OF cX Kyyr 4 , 20_L7
BY A'h�cm;'i Can q WHO IS PERSONALLY KLLO -TOME OR
HAS PROVIDED
STATE OF FLORIDA, County off
9IGNAT M OF NOTARY
FOR OFFICE USE ONLY:
Number of Open Inspections: _ 3�cv0
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
11 �YY y 4 1 1 Z
EKI
Stale of FlodtlatrySEAL' on GG 034963no20
Example: (15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212014