HomeMy WebLinkAbout2108-0108(220) permit renewal- CausleyPLANNING 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: 2108-0108(220) ADDRESS: 5351 TREE TOP TRAIL CAUSLEY RESIDENCE
I, JAMES T LEONARD , 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 SCHEDULED TO BEGIN WORK ON 3/28, PERMIT EXPIRES ON 3/27
REQUESTING 30 EXTENSION
3/7/20220
OWNER/BLD NTRACTOR SIGNATURE DATE
JAMES T LEONARD
Print Name
STATE OF FLORIDA
COUNTYOF ST LUCIE
ACKNOWLEDGED BEFORE ME THIS 7 DAY OF MARCH , 20 22
BY JAMES T LEONARD WHO IS PERSONALLY KNOWN TO ME X , OR
HAS PROVIDED AS IDENTIFICATION.
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ST OF FL RI Countyof ST LUCIE
' ►�C'� ANGE A SORSODI•BIRMINGH►M
F Notary Public . State of Florida
Commission 4 GG 249625
SIGNA OF TAR SE''F? •-' uv r- Fvmi- Aim I M77
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