HomeMy WebLinkAboutPERMIT RENEWAL REQUESTN
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
` `BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
--- — — FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578 SC BY N
St. Lucie CauEDn
PERMIT RENEWAL REQUEST h'
PERMIT NUMBER: 1604-0149 ADDRESS: 3051 Industrial 25th Street
I Michael Jacquin / Paul Jacquin & Sons, Inc. 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
SIGNATURE.
uin President
STATE OF FLORIDA
COUNTY OF stwde
ACKNOWLEDGED BEFORE. ME THIS 4th DAY OF May
BY Michael Jacquin
HAS PROVIDED
ST 9 A A, County of St. Lucie
OE NOT ARYRY
FOR OFFICE USE ONLY:
5-4-2017
2017
WHO IS PERSONALLY KNOWN TO ME X OR
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x %open = $ Renewal fee
AS IDENTIFICATION.
o.W' � Notary Public State or Florida
Gregory SKraum
y ` My Commission FF 232514
SEAL '?a Fo" Expires 05/19/2019
Example: 115 divided by 23=.65(a/o)] $I75(permit fee) x .65=$113.75 (renewal fee)
Revised 7/212014