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AG uyfi 5 '^ . ,
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
� BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: SLC 1601-0352 ADDRESS: 5925 Whipoorwill Lane
Norm Scanna ico
I, p ,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 awaiting verification from insurance company and private adjuster.
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�— - August 8, 2016
RTR�BL OR CONTRAC7MR SIGNATURE DATE
L orman Scannapico
Print Name
STATE OF FLORIDA
COTJNTY OF Florida
ACKNOWLEDGED BEFORE ME THIS 8 DAY OF August 2016
BY WHO IS PERSONALLY KNOWN TO ME X OR
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HAS PROVIDED AS IDENTIFICATION.
STATE OF��ounly of St. Lucie
SUSAN L WALKER
SIGNA I OF NOTARY A9.
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MY COMMISSION##FF184063
'?oiM1d"� EXPIRES December 16,2018
_�— (407)398-0t53 . ,.:Floridallot Senjiy�,
FOR OFFICE USE ONLY:
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Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original!permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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