HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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- BUILDING AND CODE REGULATIONS DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
DEC 19 2017
PERMIT RENEWAL REQUEST PER%TTING
St. Lucie Cou;tty, FL
PERMITNUMBER: SLC 1704-0350 ADDRESS: 10125 CROSBY PL
1, N11 eA) �YL du ,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
OWNE OR CONTRACTOR SIGNATURE 16ATE
ALLEN STEINMAN
Print Name
STATE OF FLORIDA
COUNTY OF Zga%A
ACKNOWLEDGED BEFORE ME THIS 1—DAY OF ff 20�_
BY AA%e.� (�1�{n rY'43.1r\ WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICo °�e' KimekoAlten
a Notary Public-State of Florida
STATE OF o tOf
N Commission#GG 75771
��• K,r.,el:o "9r oFFt°� Expires 2/22/2021
2
Puri,: °:ate o Flo a
SIG SEAL piss^n#GG75771
rc•s 2/22/2021
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
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