HomeMy WebLinkAboutPermit Renewals From: 02/21/2017 14:38 #096 P_0011002
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
!COUNTY I
BUILDING AND CODE REGULATIONS DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578s � �
PERMIT RENEWAL REQUEST FEB 2 1 2017
PERMITTING
St. Lucie County, FL
PERMIT NUMBER SLC1608-0111 ADDRESS: 105 Carlise Ln.
Samuel Ochstein I• iam 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 TME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification Job took longer than expected.
2/8/17
OWNERBLDR OR CONTRACTOR SIGNATURE DATE
Samuel Ochstein
Print Name
STATE OF FLORIDA
COUNTY OF Palm Beach
ACKNOWLEDGED BEFORE ME THIS 8th DAY OF February 2017
BY Samuel Ochstein WHO IS PERSONALLY KNOWN TO ME X ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of Palm Beach
""'..�`�+_ MICHELLE SCHEIN
SIGNATURE OF NOTARY nav coHnrf►sstoN a ccsoo
1�IRFS:hme 08,2029
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
I