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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
WON 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1510-0271 ADDRESS: 10600 S Ocean Dr
I, Michael Heissenberg ,am requesting that the above permit be renewed. I
understand that I must schedule 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 Condo had concrete work being done that took longer than expected putting a delay on the inspection.
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OWNER/BLDR OR C01111-TRACTOR SIONA)o DATE
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Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGEDS
QBEFORE ME THID'DAY OF 20
BY 1 MC 1 f WHO IS PERSONALLY KNOWN TO ME L- OR
HAS PROVIDED AS IDENTIFICATION.
ATE F FLO DA,County of �/', LU C )-� �y�w HEATHER V17ZO
NOTARY PUBLIC
OF FLORIDA
SIGNATURE OF NOTARY SEAL •' " ` y , FF176266
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11/1312018
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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(permit fee)x.65=$113.75 (renewal fee)
Revised 7/21/2014