HomeMy WebLinkAboutPERMIT RENEWAL REQUESTse
BY
St Luele COWtv
PLANMG AM DEVELOI
BUMDING AM CODE
2MV
FORT]"
(772) "2-1553
PERMIT
PERMIT MUMMIM
1, 65, moorc i5LGCTd,7-IC-,amrequest
understand that I must schedule and pass all required inspt
understand that this is a ONE TIME RENEWAL— and the
passing inspection during any six month period during the
Justification /3 J,//'-7 1,A-
,5, 7-,,-) vu 0 - I 'r Atw
.OR I I -
29"
0WNEMLDRQRCMTRACT0RSIGNATURE
GUY 5.V'r\00R_C
Print Name
STATE OF FLORIDA
COUNTY OF T_j*,a �aO RjqLN-
AcmowLEDr,EDBEFORE mETms DAY OF
By C' —WHO is
HAS PROVIDED
ITSERVICES DEPARTMENT
UUTIONS DIVISION
A AVE
FLW2
(772)462,IM
'AL REQUEST
co &
t the abov6 permit be renewed. I
for the permit to be finaled. Further, I
shall expire should I not receive a
it period.
I LA- W/
DATE
R C,
CA.
SEP 19 2018
Perniliccing
StLycie County, FL
_jrZ
4NIELLE P. ZIMM5
NTOME OR *.fts of Florida -Notary
ommission # 0014
AS IDENT-IA
WICATION. ootember 09. 20:
K Commission ExV
'MERMAN
'tary Public
G 141 634 P es
ED
A OF of FILQRID& _Tjakta)n RINA)c
'MERMAN
tary Public
T
AGN 61NOTA% SE&L G 141634
tf,'. '(Pires
'x ).2021
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 23a.65(*A)] $175(permit fee) x.65--$113.75 (i
Ruvimd 721=4
fee)
SEP 20 2018
Permitting luepartment
St. Lucie County, FL