HomeMy WebLinkAboutMisc Letters RECEP
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- ` � BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
5
PERMIT NUMBER: 1603-008 ADDRESS: 4100 N AlA C "a
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
OWNER/BLDR OR CONTRACTO S N URE DATE
Print Name
STATE OF FLORIDA <
COUNTY OF` ( , i
'b '�7 ( t
ACKNOWLEDGED BEFORE ME THI �✓ — DAY OF ` ) '
BY ( ► 11� (�4� lP_nVJC�t WHO IS PERSONALLY KNOWN TO ME 2�OR
,
HAS PROVIDED AS IDENTIFICATION.
TATE OF FLORIDA,Co ty of �l"7 i� l } HEATHER V1ZZa
�yg4�tpl;.cfi
I\IOTARY PUBLIC
SIGNATURE OF NOTARY SEAL "p,;:, B IRTE 4F FLORIDA
:r,'Comm#PF176266
Expires 11/13/2018
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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