HomeMy WebLinkAboutMiscellanious Letter 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
PERMIT NUMBER:1& 0:7—,0 b7 ADDRESS: /y O Y /A/- 449 J
I, I x;1 b-ert do A- & ,am requesting that the above permit be renewed. I
unders` nc that I m sc °edule 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 urin the renewal period.
Justification Ci 66'"Or WCA,iy
0WNERBLDR OR CN4 BRAC-+T®R4SI0,NFW,UREj DATE
eoo Ed i G
Print Name
STATE OF FLORIDA
4
COUNTY OF
ACKNOWLEDGED BEFORE ME TF SS DAY OF 20_7
BYZ ?_J/c VVQ�/erVHO IS PE N KNOWN ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STA OF FLORIDA,County of
r_
oSnTY fPZ9`., AUDREY B.HUMPHREY
MY COMMISSION#FF 174772
SIGNATURE OF N ARY SEAL �: 1 ;t= EXPIRES:March 6,2019
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YI•"'.R,p���°�•' Bonded Th.Notary Public Underwriters
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FOR OFFICE USE ONLY:
Number of Open Inspections: ��Y
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
RECEWED
JUL - 6 2017