HomeMy WebLinkAboutPERMIT RENEWAL REQUESTFrom: Mike Heissenberg Fax: (772) 871-0990 _ To: - Fax: 1772) 462-1578 -� Page 2 of 09,2712018 10:01 AM'-.
PLANNING. AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2360 VIRGINIA .AVE -
- WRT PIERCE, FL 34982
1 (772) 462-1553 Fax (772) 4624578
RECELVED .... .. >..
PERMIT RE
NEWAL REQUEST.. �CB�NEp
SEP 9,8 1U18 �k LUU6 CO
_..
De artment - - Un`Y
.Permitting P
St, Lucie County - .. .
PERNI TNUMBER: f3`LiG ADDRESS: tj �`�� C � _ %f Y`�
1,( iCY X If't [t�j ir3[Yz _ am requesting that the above permit be renewed. I
understand that I must schedule and ass all required inspections for the permitto be finaled. Further: 1.
understand that this is a ONE TIME RENEWAL and the pertnit shall expire should 1 not receive a
passing inspection during any six month period during the renewal period.
Justification
OWN£R`BLDR:ORCOI:T�RACTORDATE
Print Name - .. ... _
:STATE OF FLORIDA
COUNTY OFnAL ALL- f' ..
ACKNOWLEDGED BEFORE NNE THIS
.t�S_! DAY OF
BY K�1 �' C�i.C-C 3-1 P:'} j] :. ', ° luIi S PERSONALLY K` o �y 0 Nlf: _ , OR
HAS PROVIDED WfEN'I IFIL;ATIQN.
STATE OF FLORIDA. 4oudty, of Hal6igh ShortNOTARY PUBLIC
ATt1RE 01 N RY . �4a-7r�—
- STATE OF FLORIDA - ..-.
ComnrgGG14834,2 -.
N.Et Expires 6125/2021 ... ....
FOR OFFICE USE ONLY:
- Number of Open-Inspzctions;Total Inspections: -
:`(Divide open by total to get % of open inspections)-
Percentage:_ .
`Original permit fee., g %open = $� Renewal fee
_.
Example: [15 divided by:23=,65("%a)] S17,4(permit.fee) x.6;=S} 13.75 (renewal fee)
0