HomeMy WebLinkAboutPERMIT RENEWAL REQUESTFrom: Howard Simkoff Fax: 15616248037 T^,.11146215784rclax.com Fox: (772) 462-1578 Page: 3 of 4 1212V2018 10:18 AM
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
•
BUILDING AND CODE REGULATIONS DIVISION
• .. 2300 VFRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772) 462-1578
SCANNED
BY PERMIT RENEWAL REQUEST
St. Lucie County ry'�
PERMITNIJMBER: SLC1804-0466 ADDRESS: 6014 Indrio Road F7
1 Scott Berman , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be ftnaled. 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 permit expired before we could have final inspection; final inspection is scheduled
21R1
OWNERIBLDR_ ONTRACTORSIGNATURE DATE
Scott Berman
Print Name
STATE OF FLORIDA
COIJN"I'Y OF ftu %.N ,^,e,, ,,
ACKNOWLEDGED BEFORE ME THIS � DAY OF _> C-CeY I /.mac/e , 201-L
BY Scott Berman
HAS PROVIDED
WHO IS PERSONALLY KNOWN TO ME OR
ST r i OF FLORIDA, County of
kLZA�
SIG1,TATURE OF NOTARY
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
AS IDENTIFICATION. {�{
" CAFl0L A, HA6lN:fiR I.:3,
Notary Public, State of Flw:da
w, do Commission Na FF 697ri7
YyCommbetonExplr®sti71,01@
SEAL N =-0?
Example: [15 divided by 23=.65(%)J S175(permit fee) x .65=S113.75 (renewal fee)
Revised 7/212014