HomeMy WebLinkAboutPermit Renewals SEP-26-2017 TUE 02:45 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 002
R E C EP.'T SEP 720Y
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT P)ERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBERVY V�J 1 ADDRESSACWY1I
z, >am requesting that the above permit be ren dd s
understand that I must schedule and pass all required iuspectious for the permit to be inaled. Farther, I
understand that this is a ONE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justificatiou&e^ wc> uyoo ge\ cV6;�a W—kh
OWNB Ic CONTRACTOR SIGNATURE DATE
Nut Name
STATE of FLO l
COUNTY OF
ACKN WLEDGED BEFORE yTIES�Z- DAY OF
BY _ � I61 re mf l/i/ WHO IS PERSONALLY$MOWN TO AM ✓��OR
HAS PROVIDED AS IDENTIFICATION.
S TE FLOWA,County of V'
.•'"'�' ' Catherine Konger
�tCommWo #FF172372
SIGNATURE01'NOTARY F' ,:sxplrms:OCf 28,x018
+; ��•,, HONDEOTNRA
��7lma". IFr FLORIDA NOTARY,LLC
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections: '"�'�,' .
(Divide open by total to get%of open inspections)
Percentage:
Original permit flee: X%open = $ Renewal fee
Example: (15 divided by 23=.65(%)J $175(pearlit fee)Y,.65=$113.75(renewal fee)
Revised 712 1120 1 4