HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 RECEIVED
SCANNED
BY PERMIT RENEWAL REQUEST DEC 0 5 2019
St. Lucie County ST. Lucie County, permitting
PERMITNUMI3ER: /Sie2-0.36
ADDRESS: /6'9611 Alc7aN I —All
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.
Justification G/A"-z l /.y ,I/"GriTlo
CONTRACTOR SIGNATURE
Print Name
/Z —S,/�
DATE
STATE OF FLO D
COUNTYOF
ACKNOWLEDGED BEFORE ME TIES DAY OF� X , 20 1 1
BY W� � WHO IS PERSONALLY KINOWN T0� ✓ , OR
HAS PROVIDED / AS IDENTIFICATION.
=ottR„cued KA'IRINAKLUCINEC
_ OMMISSION # GG 033130
L . MY C
SEA
�r o< EXPIRES: September 26, 2020
�IFOF F�°p Bonded Thm BudgetNdary Services
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 = $ 76 � Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014 1