HomeMy WebLinkAboutPermit renewalsCOUNTY
F L
O R
I D A
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 2002-0336 ADDRESS: 5793 Moss Court
1, Karl Kandel , 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 requires final inspection
OWNS IS D OR .ONTRA OR SIGNATURE
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Print Name
6 12- q /2 1)2-0
ATE
STATE OF FLORIDA,�/�r„/6 ► COUNTY OF 1 �i�i/ �' l
ACKNOWLEDGED BEFORE ME THIS !/7 DAY OF_ G�� 20 mil/
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED _
STA OF FLORID 1. County of ■ ° v
S! N TUR-E InOTARY
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
AS IDENTIFICATION.
�P °:'11
Notary Public State of Florida
Angela StaplesSL- E_y My Commission GG 235102Expires 07/0412022
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Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
BUILDING & CODE REGULATION DIVISION
c1 2300 VIRGINIA AVENUE
.COUNTYFORT PIERCE, FL 34982
• R I D A 772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE: l
Permit # 2WZ- Q33(o
Credit Card Users: 1,5% Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA MASTERCARD
Credit Card Number 513s3 20No 5 _ Y 13c1
Expiration Date 10-22— Zip Code 3
3 digit security code 2—
Amount $ + 1.5% surcharge
Business Ni
Authorized
Print Name
Phone:
Fax:
Comments:
SLCPDSD Revised 4/01/2010 EN