HomeMy WebLinkAboutPERMIT RENEWAL REQUESTFrom: Mike Helssenberg Fart: 27728710990 To-- Fax: (772) 462-1578 Page: 2 of 3 021071202010:22 AM
PLANNING AND-DEVELOPMF-NT SERVICES DEPARTMENT
• BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553.,. pax(772)462-137V
RECEIVE ".
PERMIT RENEWAL RE_QUES FEB
ST(.�Lucie County, PerMittm9
PERT NUMB( R: DD
�` � V t
ARESS \J too
MII t l!! �LiIJ 7
am requesting.that the above permit be renewed. I
understand that I must schedule and s all required inspections for the permit to be finaled, Further, J.
understand that this is a ONE TIME NEWAL and the permit shall expire sho.u.ld 1 not.Tece,ive a
.: passing inspection during any, six month period during'the renewal period.
JustificationrRipyif
OWNER/BEAR OAP CI hNTRACTOR SIGIgA.: _ DATE
Pri7rt.Name ; SCANNED
BY
STATE OF FLO .._- .._..SI LuCle"C .
�Ur ounty_
COUNTY OF ` � -
ACKNpCpWLEDGED.BEFOREiME THIS 1 DAY OF
BY HO I.S PERSONALLY KNQ WN TQ ME Z__..OR
HA$PROVIDED
AS.IDENTIFICATION,
3 TE OF FLQR(DA, County of
_�—Shanon O'Shea
*',
NOTARY PUBLIC
BIG ATUREQI pNQTARX .. STATE OF FLORIDA.
,SEAL. Comm# GG258038
Expires 9/12/2022
FOR OFFICE USE ONLY:
Number of Open lnspections:
Total Inspections: _ get% of op -
. (Divide open by total to en inspections)'
Percentage: ..
Otiginalpeltnitfee: x°lo.o en= $ _...........-_.......
p Rene�ual.fee
Example: (ISdiyid;,tl.by, 23=.65(%)J$175,(pia it.fee)x.65-S11 .7o(renewal.fee) "'
Revised 7@I/2014
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