HomeMy WebLinkAboutrenewal requestPLANNING 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: 2105-0432 ADDRESS: 6 Brisa, Port St. Lucie, 34952
I Matthew Wynne , 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 Need final inspection
SIGNATURE
Matthew
Print Name
STATE OF FLORIDA
COUNTY OF Florida
ACKNOWLEDGED BEFORE ME THIS 18
BY Matthew Wynne
HAS PROVIDED
STATE_OF��IP ,ORIDA, County
2/18/22
DA
DAY OF February 202022
WHO IS PERSONALLY KNOWN TO ME ? , OR
_. AS IDENTIFICATION.
SUSAN LAFLEUR
My�,F�ISSION S GG 356204
EXPIRES: February 23, 2023
Bonded Tho Notary Public undenvdlei
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(0% l $175(permit fee) x .65=$113.75 (renewal fee)
Revised 721/2014