HomeMy WebLinkAboutPermit Renewal Oct 01 18,01:13p Cool Air Solutions of FL 772-801-5398 p.1
dimiimmommh PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
C O .. "
Cat.lNTY BUILDING AND CODE REGULATIONS DIVISION
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f•• it 0 ,R .1 v. A - - 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1803-0434 ADDRESS: 2023 St Lucie Blvd Lot 278
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 The owner is out of the country
c,.jL 9127118
OWNE LDR OR CI CTOR SIGNATURE DATE •
Shyan Wojtczak
• Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS 0-421411 DAY OF - tY ` ,20 i
BY WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED FL- -DL---C AS IDENTIFICATION.
STATE OF FLORIDA,County of j , 'n , ^ � ..,'::.:t.°=` s.�.,:r"": "`" °"'•::: '::._..:.
�' �� 4-�{.:�{� ao:P--� ; SAVITRI GARCI:, •
a C ��E 21 r 5`2 1'.`c Notary Public-Stata o1 Florida
.
SIGNATURE OF NOTARY ;` Commission# EF 966265
•4 r... My Comm.Expires Apr 1,2020
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=5113.75(renewal fee)
Revised 7/21/2014