HomeMy WebLinkAboutMisc Letters PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: (0,0 3 (� ( rI �` ADDRESS: 2—(,,,O S ESSS?C T-) P,
I, ot"3�t-W- C'A,r_y'�ou ,j ,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 Ca t,.�, n-Acw v>` c3 NA-U s c c�J
o / l Z l l
O LDRO�R"CONTRACTOR SIGNATURE DATERE
S�T-�. .�G�i7 t�F✓+4-3�v rll S--Ari �J6�lGiwL li [!��f )
Print Name OCT 12 2016
PER
St. Lucie County, I'L
STATE OF FLORI 1
COUNTY OF
ACKNOWLEDGED BE F RE ME THIS�ZL DAY OF 2,
By WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE F"FL�ZDA, ofKAREN S. NIELSEN
SI ATU - Corr�r�AsLsion # FF 115637
.= CC
My ommission Expires
June 12, 2018
--------------------------------------------------------------------------------------------------------------------------------------------------
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
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014