HomeMy WebLinkAboutPermit Renewals Nov 0719, 12:23p Cool Air Solutions of FL 772-801-5398 p.1
PLANNING AND DEVELOPIVIENT SERVICES DEPARTMENT
0
- i - BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGIMA AVE
FORT PIERCE,FL 34992 RECEIVED
(772)462-1553 Fax(772)462-1578
NOV 0 7 2019
PERMIT RENEWAL REQ T
ST. Lucie County, Permitting
_PERMIT NUMBER: 1903-0475 ADDRESS: 4000 N Hwy Al A#501
L 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 final ed. 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
11-7-19
OWNER LDROR CONT TOR SIGNATURE DATE
Shyan Wojtczak
Print Name
STATE OF FLORID L
COUNTY OF �or.
ACKNOWLEDGED BEFORE ME I'MS DAY OF (v0✓P s-n b el ,20 i
BY "1 �() j }jL Zy(C WHO IS PERSONALLY KNOWN TO ME OR
J nn
HAS PROVIDED (mil L AS IDENTIFICATION.
STA RIDA,Count f
I1*CE"194t�rl-
Erich Daniel Krach
NOTARY PUBLIC
SURE OF NOTY STATE OF FLORIDA
Comm#GG105925
Expires 5117/2021
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 23=.65(%)].S175(permit fee)x.65=S 113.75(renewal fee)
Revised 7/21/2014