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
SCABNNED PERMIT RENEWAL REQUEST RECEIVED
St. Lucie County JAN 08 1010
7 /� j /\ �/�f�n nPermRting Deppart /e �
PER MIT ROM — S L, ADDRESS: In(
I)(J 1 l ) ( Ol lU I I V �t ��CT_�V
1, M � l V 1 s am requesting that the above permit be renewed. I
understand that I must schedule and pas§ 4ql 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
KGnQ21
Print Name
STATE OF FLOR'V 1 1 ^I�
COUNTY OF C ^/"xI'' II I rnAI/
ACKNOWLEDGED BEFORE ME THIS-- DAY OF �l.0 y , 201
BYMichapj h0jM WHO IS PERSONALLY KNO TOME -�, OR
HAS PROVIDED
S TE OF FLORIDA, Count of Cl I - Lu&e-
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.
Ry Shanon O'Shea
NOTARY PUBLIC
=STATE OF FLORIDA
i Comm# GG258038
ee Expires 9/1212022
Example: [ 15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
PC5