HomeMy WebLinkAboutPermit Renewal 04./02/2018 19:37 17723341078pu PAGE 02/03
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT MERCE,FL 34982
(772)462-1553 Pslix(772)462-1578. RECEIVED
PERMIT RENEWAL REQUEST APR 0 5 2018
ST. Lucie County, Permitting
PERMIT NUMBER, 11 0'3 t5ADDRESS: 50 '5, QC46-n-bt !K-03
ain requesting that the above permit be.renewed. I
understandthatI must schedule and pass al �uired inspections for the perrnit to be finalod, Further, I
understand that this is a_QNE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection'during any six month period during the reuewaJ period,
Justification
INER/yLDR QR CONTRA Old SIG�A 1*URE. DATE
JOLVI-e:t L—C—i
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE-ME T141Sj<2�DAY OF
BY WI-10 IS PERSONALLY KNOWN TOME_____,OR
HAS PROVIDED AS IDENTIFICATION.
Y Csthoirw Ann Weinman
ST OF FLORID ,fir. NO PU13LIC
STATE OF FLORIDA
t'VC , —Expires 8/23/2010
SIGNATUI�Z-01;-NVTAK, pernaW FF145934
FOR OFFICE USE ONLY-
Number of Open inspections,
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee! x IN,open Rcncwal fee
Example, [15 divided by 23=,65(/o)] $175(perrnit rea)x .65=$113.75(renewal fee)
Revised 7/2112014