HomeMy WebLinkAboutRenewal notice PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
Sol 2300 VIRGINIA AVE
MW
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
RECEIVED
PERMIT RENEWAL REQUEST APR -3 2010
Permitting Department
St. Lucie County
PERMIT NUMBER: 1710-0248 ADDRESS: 122 Queen Eugenia Ct
I, Shyan Wojtczak '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 Homeowner just got back from Russia
9 \� L; C,-IL 4/20/18
OWNEWBLDR OR C CTOR SIGNATURE DATE
Shyan Wojtczak
Print Name
STATE OF FLORIDA
COUNTY OF �t`a`d !moi IICQ
ACKNOWLEDGED BEFORE ME THIS DAY OF .�� '�\ 120 6 cIi'
V
BY S �l�a v� V 'uS d C•'?0 WHO IS PERSONALLY KNOWN TO ME ,OR
i
HAS PROVIDED l Lam— AS IDENTIFICATION.
STATE F FLORIDA,County of ��C `u �-1e """"• —'
.o FAZIA SEMAM
rj� 71,co_ Notary Public-state of Florida
My Comm.Ex Ires Aug ,.
SIGN OF NOTARY SEAL Commission 22.2o1s"
�'FF 144129
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(0/D)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014