HomeMy WebLinkAboutPermit Renewals To: Page 2 of 3 2018-06-19 15:23:56(GMT) / 19542522244 From: Lloyd Falk
Mal
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE.REGULATIONS DIVISION
2300 VIRGIMA AVE
RECEIVED C.72)46°15RT 5 3 F x�)462-1578
JUN 2 0 2018
PE PMT RENEWAL REQUEST
ST. Lucie County, Permitting
PERMIT NUMBER.:ti,�'<&06r'&) ' ' ADDRESS:
I L�� 7 t� '�1� ,am requesting that the above permit be renewed. I
I,
that I:must schedule and pass all required tnspections for the permit to be finaled. Further,I
understand-that this is a ONE TIME RENEWAL and the permit shall.expire should I not reeeive a
passing inspection during any Six month period during the renewal period.
justification q QHS jsja �; nil nller
T
/ ►�/2_DW
'6WNERI&bR OR CONTRAC OR SIGNATURE ATE
L_L.._If H• F�?--4-K
Print Name
STATE OF FLORIIbg0�A9,
COIJN7"i't)F
ACKNOWLEDGED BEFORE �� Y ME TIES ` DAOF j lAYX-R— .20
BY .� LDS WffO IS PERSONALLY KNOWN TOME V OR
HAS PROVIDED AS IDENTIFICATION.
STATE.OF FLORIDA,County of .6Pl't"30
.> Notary Pubfic.state ot Florida
Amberleigh Clark
-'r+ ri«• My Commission GG 175169
SIGNATURE OF SEAL 4 Expires 01/1512022
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 = S _Renewal fee
Example: [15 divided by 23x.65(%)i S175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21=14