HomeMy WebLinkAboutPERMIT RENEWAL REQUESTA
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
make 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 t"
(772) 462-1553 Fax (772) 462-1578
,56ANNED RECEIVED
�`Y PERMIT RENEWAL REQUEST
St Lucie County JUL 2 3 -' 019
ST. 6ucir Onunty,±"P�rmitting
PERMIT NUMBER: 1802-0468 ADDRESS: 3119 S Indian River Drive
I Dale Gasparik , 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,,L
passing inspection during any six month period during the renewal period.
Needed more time for Engineer Stamped Drawings & Project Requirements for Final
Justification 9 P 9 1 q
(�^ 07.15.2019
OW1T2f,/BLDIeOR CON RACTOR SIGNATURE DATE }'z
Dale Gasparik
Print Name
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STATE OF FLORIDA
COUNTY OF St Lucie
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ACKNOWLEDGED BEFORE ME THIS 15 DAY OF JUIY 2019
BY Dale Gasparik WHO IS PERSONALLY KNOWN TO ME X , OR
HAS PROVIDED AS IDENTIFICATION.
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STAT F LORIDA unty of St Lucie ;•ar}`Y?� '; REGINA NELLBERG
MY COMMISSION # GG071648
EXPIRES February 09, 2021 j
SIGN RE OF NOTARYSEAL
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(perrnit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014