HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT:SERVICES DEPARTMENT
BUILD
ING AND CODE REGULATIONS DIVISION•':
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-,2300 VIRGINIA AVE.
{; FORT kikiG ,FL 34982
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(772)463,1553 3 .Fas(772)462-157$'
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WAL REQUEST
t PERMIT NULIBER 1.8Q4-0617 ADDREss .2:14 SE-Camino Street,;Port St Lucie, FL
Kevin R: a aszek.
I; tYl am 'requesting that,the above.peimlt be renewed I
understand that:I must schedule:and•pass;a11-required ins pections;for the permit to'be finaled Fuitlier,I
' pakrst6s g spection during any'six monpeE od during the renewtt.al pe11�`oedxptre should-4 not receive a"
Justification Trouble.coordinating:finaleinspection/oversight
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-'-,'-' ':0WNER/BLD COMRA CTOR SIGNATURE DAA
Print Name .-
STATE OF FLORIDA�
COUNTY OF
ACKNOWLEDGED BEFORE ME.THIS DAY.OF
BY,-" VlA IZ 'MA�VlQsz wx0_IS PERSONALLI'KNOWN TO-ME
HAS,PROVIDED u�a AS IDENTIFICATION:
S T OF LORID
CEUNA ROM
�y:,Notary Public•State of Florida
SIGNATURE_ t
Commissien 0 GG 952911
:OF NOTARY o�rti. m.Expires Jan 29,2024
`,
Bcnded through Nationat:Notary Assn
TO OFFICE;USE ONLY:: :
Number,of 0pen,Inspections:.
Total Inspections
lvMde o en b g
(D p y total to et%of-open inspections) k
} -Percentage: - - -
Ori ' al ermit fee: : x%open $.;. Renewal fee
P P
Example {IS divided by 23 .65(%)] $175(permitfee)) 65 $. 13,75(renewal fee)
Revised 7/2172a,14
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