HomeMy WebLinkAboutPERMIT RENEWAL REQUESTr .riNNING AND DEVELOPMENT SERVICES DEPARTMENT " %
BUILDING AND CODE REGULATIONS DIVISION
2300 V IRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
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PERMIT RENEWAL REQUEST St�G
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PERW17NNUMBER: 190(0—Olttn ADDRESS: 91'Jy Syet nA �Aole
I, cz�/J!' m ( h am requesting that the above permit be renewed. I
understand tKat I must schedule and pass all required inspections for the permit to be £coaled. 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 [MeJo' IL G CA.- k
O R/B DR OR CONTRACTOR SIGNATURE
RyQA W. t k
Print Name
STATE OF FL nA
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DATE
SCANNED
BY
St. Lucie County
ACKNOWLEDGED BEFORE ME THIS 7 DAY OF r�F-�f) t •� , 20 t
BY I W AW j WHO IS PERSONALLY KNOWN TO ME ✓ , OR
HAS PROVIDED AS IDENTIFICATION.
STATED F Countyo �/1-�VYt �eylcc. Ct
;off, STEPHEN S. BELTON
io`jP acj;State of Florida -Notary Public
S A NO R - •- Commission # GG 252922
h �` My Commission E2xpffes
02, O
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 7/21/2014