HomeMy WebLinkAboutPERMIT RENEWAL REQUESTFrom: Mike Helssenberg Fax: 1772871099 0 To: Fax: (772) 462.1578 Page: 2 of 3 10021/2019 2:43 PM
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PLANNING AND DEVELOPMENT SERVICES DEPARIWIEN.T . ( V
BUILDING Al -CODE REGULATIONS. DIMS
2300 VIRGINIA-AVE RECEIVED
FORT MERLE, FL 34982
(772) 462.1553_ _Fax (772):462-1578 ... . U T`2`1. 201
SCANNED
BY ST. Lucie County, Permittin - PERMIT RENEWAL.REQUEST e
viie County _
PERMIT
,NUMBER; ADDRESS:
am requesting that the above permit be renewed. I
understand that I must sc eduh le and s all required inspections for the permit to be finaled. 1 urther, l
understand that this is a ONE TIME RENE+F'AL and the permit shall expire. should I not receive a
passing inspection during any six month period during the renewal period.
Justification
/4
)D1��
OWNER/BLDR O C NTRAC"RIC;NTUBE DATE
STATE OF FL A ....: .
COUNTY OF , CtT��,[.l�l(.�... ... .
ACKNO"wLEDGF.DBEFORPMETHIS ....1_b--..DAY.OFLei
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By WHO WHO IS PERSONAi,LY KNOWN TG.Mk _I, OR
HAS PROVIDBD AS. IDENTIFICATION.
'STATE OFFLORIDA,Ceuntyor. \�• h
�- f f Aim t R Shanon OShea
SIGNATURE O NOT�Y v NOTARY PUBLIC
STATE OF FLOgIt7A
Commill 0026Mil
t 1 Expires 9!!
FOR OFFICE IJSE ONLY:
Number -of Open Inspections:
Total Inspections:
............. ...... .. .. ....:
(Divide open by total to set.9/o of open inspections) ....
percentage; � . , � �.........._..._........ . ..............._.......
Original permit fee: x % open = $ Renewal fee
_............ ..... ....... . .. _...
Example;, [15 divided by23=.65(%o)] SI75(permit'fee) x.65=5 113.75 (renewal fee)
. Rc LFed 721.2014 -
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