HomeMy WebLinkAboutPermit Renewals JAN/27/2017/FRI 12;33 PM FAX No, P. 001
PLANNING AND DEVELOPM[ENI'SERVICES DEPARTMENT
r 3.,... BUILDING AND CODE REGULATIONS DIVISION
".� 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)442-x553 Fox(772)462-X578
PERMIT RENEWAL REQUEST
PERMrrNUMBER: C1507-0967 ADDRESS; 2209 S Edwards Rd
Matthew McClellan 'am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be;f?inaled- Further,I
understand that this is a ONE TIME RENEWAL and the pem-dt shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
1127/2017
OWNEit/)3I.1DR OR CONTRACTOR SIGNATURE DATE
Matthew McClellan
Print Name
STATE OF FLOPZDA,
COUNTY OF seint Lucie
ACKNOWLEDGED BEFORE ME THIS 27 DAY OF,January ,2017
BY Samuel Cabrera WHO IS PERSONALLY KNOWN TO NM OR
HAS PROVIDED License AS IDENTIFICATION.
STATE OF FLORITiA.,County of Saint Lucie p
'
Notary Pupilc Stat6 of Fiotida� Samuel cabrere
My Corhritiesian FF 910529
SIGNATURE OF NO SEAL S Eora%08/1812019
FOR OFIRU USE ONLY:
Number of Open Inspections.
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original,permit fee: x%opera $ Renewal feeO @ .��rn D
Example: [15 divided by 23=,65(%)1 $175(pcmait fee)X.65=$113,75(renewal fee) JAN 3 0 2017
Revised 7/21/2014
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