HomeMy WebLinkAboutPermit Renewals 10-18-17;23:04 ;From; To:7724621578 ;7724618722 # 2/ 3
:.......... ..: ::,:•.:.: PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
« 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 rax(772)462-1578
R 1=CEI';;D OCT 19 1017 PERMIT RENEWAL REQUEST
PERMIT NUMBER: �lJ_0O"7.... ADDRESS: ' _ Z� -1r� .j
1, �............ am requesting that the above permit be renewed. I
understd that I must schedule and pass all required inspections for the permit to be iinaled. 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.
Justifiicafiion �
Y1
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-- 1019 1 ,1
R/BLDR DA CONTRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS�� DAY OF W......... r'TGtB��2 20
BY •_%Jazn if- J�;r//Yl�FX WINO IS PERSONALLY KNOWN TO ME _,OR
HAS PROVIDED AS IDENTIFICATION.
STAT- F FLORID4,County of �� Z..Gf Cl,.-,- •-
re"''• SUSAN MONTENEGRO
IG ATURE OF NOTARY SGA =ter MYCOhtIRE$.A 0 ,2 2
EXPIRES•Aar112,202!
,t'` SoW Ttiu Notavy Pub6a UAQafwMw
........------------........-------------------.......,.. -------------------------------------.........
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get°/u of open inspections)
Percentage:
Original permit fee: x%open $ Renewal fee
Example: [I$ divided by 23=.65(%)] $175(permit fee)x.65,S113.75 (renewal fee)
RcAsed 7/21/2014