HomeMy WebLinkAboutPERMIT RENEWAL REQUEST. . '7i' .
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PER/M�,I,T NUMBER /�(O 0 b— 01Ea3 ADDRESS: 9G 7 'S
I, III ;Give I r 'd 2 am requesting that the above permit be renewed. I
understand that I must 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.
w. 1 a I A_
OR WNTRACTOR SIGNATURE
0)1,r- np—) pri de
Print Name
STATE OF FLORIDA
COUNTY OF --�A i aT Ltl.Cit
)28A9
DATE
SCANNED
BY
St. Lucie County
ACKNOWLEDGED BEFORE ME THIS M DAY OF emu. , 20 19
BY' N-mIEL- WHO IS PERSONALLY KNOWN TO ME V OR
HAS PROVIDED
`\STA/T'E OF FLORIDA, County of _�xA t aT
SIGNATURE OF NOTARY
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
AS IDENTIFICATION.
MONICA
n�''�.
.4z=_CommisslonAGG070973
CASAN
S ?`s Expires June8,2021
e;f,.,,,t�$'+' BgdedThuTrv/Faietmurama 8003867019
Example: (15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
n134t3 IMF)rAlEI
JAN 2 8 2919
Permitting Department
St. Lucie County, FL