HomeMy WebLinkAboutPERMIT RENEWAL REQUEST512019 15:30 P.001 l002
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING ANI) CODE REGULATIONS DYV'ISXON
2300 VIRGWU AVE
am, 1 OAr NlEACE, FL 34982
�p�p
(772) 462-1553 Fax (772) 462-I578
SCANNED
BY PERMIT RENEWAL REQUEST
at. Lucia County
PERMIT NUM$BR: 1807-0104 ADDRESS: .5001 Pinetree Drive
t Cheyenne Ellison , am requesting that the above permit be renewed. I
understand that 1 must 'schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE 'YAd RENEWAL and the permit shall expire should I not receive a
passing inspection during any sir month period during the renewal period.
justification Job not yet completed
0 RB R OR CONTRACTOR SIGNATURE
Cheyenne Ellison
Print Name
STATE OF FLORIDA
COUNTY OF Msnln
2115/19
DATE
ACKNOWLEDGED BEFORE ME TIUS 15 DAY OF February , 2 19
.By Cheyenne Ellison WIIO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED AS IDENTIFICATION.
S ATE OF,FLOR , County of Martin
SION R F
FOR OFFICE USE ONLY: n/10
Number of Open rnspections: j�
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
Notuy Pubfic stale of Frariea
N
Desiree McIntosh
gP-0'0�;
My Commission GG 283399
SEAL �jExpires 1211112022
Example: [15 divided by 23=.65(n/o)] $175(pennit fcc) x .65=$113.75 (renewal fee)
Revised 7/21/2014