HomeMy WebLinkAboutPERMIT RENEWAL REQUESTe�
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISIONECEIVEo
2300 VHtGINU AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772)462-1578 DEC 0 6 2610
SCANNED Permitting Department
BY PERMIT RENEWAL REQUEST st• Lucie county
St. Lucie County
PERMIT NUMBER: I807-03d ADDRESS: !1601 S Oee•4n ,ert5en ( cc%t I L
3�/?57
®� am requesting that the above permit be renewed. I
understand that I must schedule and pass all required' inspections for the permit to be Snaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should 1 not receive a
passing inspection during any six month period during the renewal period.
Justification 2< �r Di «l 1 —Fo b� ah(c -(0 5a
/X6frl6Ae/P('G-(;0r. 172 nfo5e�_ oe.:n„-2L--
OWNER/B1 D _CONTRACTOR SIGNATURE I ATE / ZO(
(gem-) �alic
Print Name
STATE OF FLORIDA S
COUNTYOF :">(l(1fA%y'%
ACKNOWLEDGED BEFORE ME THIS i-\ DAY Ofa eC'fv,n%rN . 20/n
BY _VF:.X}yN \ (1 \���� WHO IS. PERSONALLY KNOWN TO ME ✓ , OR
HAS PROVIDED _ AS IDENTIFICATION.
STATE OF FLORIDA,
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
,eellia Rase Hairs
40TARY PUBUG
;TATE OF FLOR10A
�trgiraa 91i®12029
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014