HomeMy WebLinkAboutPermit Renewals (2) PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
MOM2300 FORT IE CINIA E,FL 4982 RECEIVED
(772)462-1553 Fax(772)462-1578
NOV 15 2018
PERMIT RENEWAL REQUEST ST. Lucie County, Permitting
PERMIT NUMBER:
SDRESS: 5 - ii\leo Qy, o, E.
I, V Gs Sal 3 ,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
OWNRRB DR OR CONTRACTOR SIGNATURE DATE
�r'SCn /"[ 'Qrv�fi
Print Name
STATE OF FLORIDA
COUNTYOF S-• LccL rrr
ACKNOWLEDGED BEFORE ME THIS 1?DAY OF %V10 U/Gyn r 20
R
BY<,� 1�,h I 1 C1 r WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORICouLt�
Yp;,/ KAREN S. NIELSEN
SIG ATURE O OT Y c�� ��;State of FIg y Notary Public
commiGG 207484
My Commission Expires
''0''%%` June 12, 2022
FOR OFFICE USE ONLY:
Number of Open Inspections: �✓`�p I� .
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