HomeMy WebLinkAboutPermit Renewals 02-01-17;05:28 ;From: To:7724621578 ;7724618722 # 2/ 2
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
ldY BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1602-0328 ADDRESS: 5101 N AlA, FORT PIERCE, FL 34949
SUSAN MONTENEGRO ,am requesting that the above permit be renewed. I
understand that I must srhcdule and pass all required inspections for the permit to be finaled. 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
C 142QI7
YNEXVB—LDP,MCONTRACTOR SIGNATURE D
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE MET141S DAY OF J'-0�8aZl' , .20 / 2
8Y �s
��ezy- W140 IS PERSONALLY K/OWN TO MEe_�,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA.County f
ATUA% Ift
RE OF NOTARY SANDRA HOHMANN
Notary public-S1810 of Florida
'-My Comm,Expltz-7,lar 14,2018
I nE --- ---
FOR OFFICE USE ONLY: Bonded 7hrough National Notary Assn•
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(pormit fcc)x.65-$113,75(rencwal fee)
Revised 712112014 Zr>