HomeMy WebLinkAboutMisc Letters M w PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
o � BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,:FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: r n ^000 1-715ADDRESS: 7/o3
O tr F}
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_eu6-�[7 e'r- ' �-t ' k-��1 �1,�-�- `�'n5�'��p�
-b 7
OWNER/BLDR ONTRACTOR SIGNATURE IbATE
Print Name
STATE OF FLORIDA. f
COUNTY OP
AC' OWLED BEFORE ME THIS { �]
L DAY OF `' ,20 r
�cs,�
BY .WHO Is PERSONALLY.. OWN TO ME ,OR
HAS PROVIDE AS IDENTIFICATION.
STA FLORIDA,C unyof � ��/`� THOMAS H•DABERKO
+� NOTARY PUBLIC
Sl NATURE OF NOTARY - STATE OF FLORIDA
V�ni'-75�
Commt�FF128494
Exp:ros.
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%ofopen inspections)
Percentage:
Original permit tce: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renc%%2I Fee)
Revise)71-71=14
RECEIVED
JUL 17 2017