HomeMy WebLinkAboutPERMIT RENEWAL REQUESTa V L9 H '__U�
%PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VHtGINIA AVE
FORT PIERCE, FL 34982
C772) 462-1553 Fax C772) 462-1578
SCANNED
BY PERMIT RENEWAL REQUEST
St. Lucie County
PERmrrNuNmER:.1911766"L�' ADDRESS: ftZ r>
At &CA
L Ak-Off #-e—LAE92ft am -requesting that the�above permit he renewed. I
understand that I must sched4e,and pass all required inspections for the petmit to be finaled. FurtherI
understand thatthis is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection dR�mg ImY SiX mop$h period during the renewal period.
STATE 0 A
COU I NTY0PfLA$3 eeLA'_\
ACKNOWLEDGED BEFORE W THIS ZrJDAYOF 6(:,f�6CV 2012—
BY OASa U WHO IS PERSONALLY KNOWN TOW _�ZOR
-RAS PROVIDED AS IDENTIFICATION.
STAT"F F LORIDA, Coumly of
-SMATURE OF NOTARY i?PRV% N6WFUb11C State of Florida
"% Abigail Rae Langwiler
4F bra,]FRe Lean
%y,My Commission GG 225260
'Y�V Expres G610512022
FOR OMCE USE ONLY
Number of Open Inspections:
Total Inspections:
(Divi4e open bj total to get % of opeh. inspections)
Percentage:
Oridnal permit fee: . x �/o open = S Renewal fee
Example: [15 divided by 23=.65(D/a)] $175(permit , fee) x .65=S1 13.75 (renewullike)
Revised 7/21t2014