HomeMy WebLinkAboutPermit renewal request qr
_ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
'- FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
,` 1A RECEIVED
M%E RENEWAL REQUE T
APR ® 9 2019
i
ST. Lucie County, Permitting
PERMIT NUMBER SLC-1809-0118 ADDRESS: 15382 NAVION DRIVE, PSL, FL 34987
I, MARK COLLINS ,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.
Justificati E RENEWAL-4S TO RESCHEDULE THE FINAL INSPECTION
LDR CTOR SIGNATURE TAT�'E�—,�—
I
MARK COLLINS
Print Name
STATE OFR
A Al
COUNTY OF
ACKNOWLEDGED BEFORE ME THISy DAY OF%'�/Y ,20
BY �� � ���nJ WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.``111111111►1���
§11�aPISY M,P z
STATE OF 727
Co of � � `�` ,•GOMM�SSr0* .
;JNE 27,? y
SIGNA E OF A SEAL = * �.• N. =
*GG 077747
FOR OFFICE USE ONLY: ���!f ll1111110 ` o\\a`
Number of Open Inspections:
Total Inspections:
(Divide open by total to Iget%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
I