HomeMy WebLinkAboutPermit Renewals To: BUILDING DEPT PERMITTING Page 2 of-2. 2017-07-28 19:58:27(GMT) 18666845854 From:Scott Hixon
;;;���<;��s • '_:.�"�4�• PLANNING AND 1�1E VELC1'PIO�I!-NT SERVICES DEI'ART1I�CI'
.. . BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-M53 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: SLC-1610-0128 ADDRESS: 3354 NW PERIMETER RD
F W S HIXON ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the perrnit to be finaled. Further, I
understand that this is.a ONE TIME RENEWAL and the permit shall expire should Y not receive a
passing inspection during any six month period during the renewal period,
Justification
JULY 28, 2017
04VNER/BLDR OR CONTRACTOR SIGNATURE DA'L'E
W S HIXON
Print Name
STATE OF PLORIDA
COUNTY OF —N
ACKNOWLEDGED BEFORE ME THIS 28TH 'DAY OF_JULY 20.17
BY KATHLEEN MOUTRAN W7IOIS PERSONALLY KNOWN TO ME X — OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,Couirty of MARTIN 't •r KA
Tl LEEN o�,� ¢,
/ MY COMMISSION#FF86SO4:
SIGNATURE OF NOTARY� SEI '••.4!,,, SIRES July 93,2019
t$onsse.o+.oa �lw�7aarY9ecvico.�rr,
- -— ------------------------------_------------_-----------------------------
FOR OFFICE USE ONLY:
Number of Open Inspections:
Tota{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(pennitfee)x.65=S113.75(renewal fee)
Revised 7/21/2014
RECEIVED
JUL 2 8 2017