HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENCC-
2300 BUILDING AND CODE REGULATIONS DIVISION
VIRGINIA AVE
FORT PIERCE, FL 34952
(772) 462-1553 Fax (772) 462-1575
SCANNED
BY
St. Lucie County
PERMIT NUMBER: 1807-0031
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ADDRESS: 4690 Emerson Ave, Ft Pierce, FL 34951
PERMIT RENEWAL REQUEST
I Michael Poirier , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be frnaled. 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 Due to scheduling changes with Verizon Wireless our permit has reached
or neared its expiration date.
Cy i / 8 /
OWNERBLDR OR CONTRACTOR SIGNATURE DAT
Michael Poirier
Print Name
STATE OF FLORIDA
COUNTY OF Palm Beach
ACKNOWLEDGED BEFORE ME THIS 18th
BY Michael Poirier
HAS. PROVIDED
DAY OF November 2019
WHO IS PERSONALLY KNOWN TOME El-�, OR
AS IDENTIFICATION.
STATE ORID Cgyntyof �a�YY��DCW +;✓"%L'., FANNY LIZETTE COBO
MY COMMISSION ri GG045691
oFdOTARY SEAL a„ EXPIRES November 08. 2020
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 23=.65(%)] $175(pernut fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014