HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982�'��,� D
cn�Ls (772)462-1553 Fax(772)462-1578
NOV 0 8 2017
PEI;^fifl71P1.rs PERMIT RENEWAL REQUEST
St. Lucie County, FL
PERMIT NUMBER: 1702-0500 ADDRESS: 3521 Sunrise Blvd.
I, Wanda Gahn ,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 _C pm YYI(, ni m4-i ni ex ro r
17
OWNER/BLDR OR CONTRACTOR SIGNATURE DAT
Wanda Gahn
Print Name
STATE OF FLORIDA
COUNTY OF St.Lucie ,I c
ACKNOWLEDGED BEFORE ME THIS ! 4 DAY OF 20_/q
BY W and a C-7ahn WHO IS PERSONALLY KNOWN TO ME X OR
HAS PROVIDED NSA AS IDENTIFICATION.
STATE F FLORIDA?C4nty St. Lucie Kristina R.parsons
�XWA Q NOTARY PUBLIC
1.4 STATE OF FLORIDA
SIC"OF NOTARY SEAL y Comm#GGM836
.s1NCE I Expires 4/2312021
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
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014