HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DiVI,5
23Qb''VMGMA AVE 'RECEIVED
FORT PIERCE,FI,34982
(772)462-1553 Fax(772)462-1578 APR 16 2019
PERMIT RENEWAL REQUEST ST. Lucie County, Permitting
PERMIT NUIVBER. SLC 1809-0123AnnREss: 171 NE Caprona Ave
I, David 1. Spalding am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to he 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 permit has expired
4/15/19
OWNWBILDR.OR CONTRACTOR SIGNATURE DATE
David L. Spalding
print Name
STATE OF FLORIDA
COUNTY OF 0:1114A.1a -- nn Q
ACKNOWLEDGED BEFORE hIE THIS �L7 DAY OF �G.t..0 �� � /
BY V� j,�( �, W O IS PERSONALLY KNOWN TO NO_ ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of � CYNTHIA J DAY
Notary Public-State of Ftcrida.
STGINA OF NOTARY ' Commission#FF 976346
,a FPt,.•�`` My Comm.Expires Jul 9,2020
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections-
(Divide open by total to get%of open inspections)
Percentage: r
Original permit fee: x%open = $_gE�Renewal fee
Example. (I S divided by 23--.65(%)] $175(perinit fee)x.65=$113.75(renewal fine)
Revised 7/21/2014
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