HomeMy WebLinkAboutEMARK PERMIT EXTENSION FORM PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
® BUILDING AND CODE REGULATIONS DIVISION
1 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1579
PERMIT RENEWAL REQUEST
PERMIT NUMBER: J 2 C, 21 0'1 — (J 61 ) ADDRESS: 11 El Camino Real Port Saint Lucie, FL 34952
I DANIEL BECKNER , 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 daring the renewal period.
Justification Due to Covid -19 we have experienced set backs our product is to arrive
soon .
1 /31 /2022
x OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
DANIEL BECNER
Print Name
STATE OF FLORIDA
COUNTY OF sr LuaE
ACKNOWLEDGED BEFORE ME THIS DAY OF 20
BY (/ck Vt` [�t I{J}}C- ( �'^l.Q�, f� WHO IS PALLY KN TO ME , OR
HAS PROVIDED iy �� I,} CUA pY�'e h Le' AS IDENTIFICATION.
STATE OF FLORIDA, Count f Sj I Lk SAQUOAWKWTOH
?` ` %% MYC0MMIS$M # H1H2O3974
EXPIRES: D9W Mber 2, 2025
SIGNAT OTARY SEAL '.,
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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(pennit fee) x .65=$ 113 .75 (renewal fee)
Revised 7/21/2014