HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 r V E
PERMIT RENEWAL REQUEST MAY 11 2017
PERi'ArFrING
St. Lucie COUnty, F=L
PERMIT NUMBER: 1611-0316 ADDRESS: 911 Emerald Ave Fort Pierce, FL 34945
I, Matthew Guettler ,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 Work is not yet completed
05/11/2017
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Matthew Guettler
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 11 DAY OF May 2017
BY Matthew Guettler WHO IS PERSONALLY KNOWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
ST F FLORIDA,County of St Lucie
aosAa °UBS% SHARON M.MORRIS
* MY COMMISSION#FF 136734
SIGNATURE OF NOTARY 5011EXPIRES:July 31,2018
Sharon M Morris Commission Expires: 7/31/18 Bonded Thru Budget Notary Services
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