HomeMy WebLinkAboutMisc Letters (2) 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: l J j2 ADDRESS: �00 V'GI.5 ('Q/A �t
I, '04L O4 Z (ce 'Q•/ ,am requesting that the above permit be renewed. I
understand that I musts hedule 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
OR CONTfKCTOR SI ATURE T DATE '
G ��-a. /�� GQ✓
Print Name
STATE OF FLO
COUNTY OF li
ACKNOWLEDGED BEFORE ME THIS G DAY OF 20
BY A Lon f4C c67 T�WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATEZFDA Count f Y7 l,t;,` =o '•PALPH MARION HARVEY III
County � �, '`:°
•I •I MY COMMISSION#FF118990
EXPIRES May 4, 2018
zz
SIG OF NO SEAL (407)998111 53 FloridallotaryService.com
FOR OFFICE USE ONLY:
Number of Open Inspections:
_°�` RALPH MARION HARVEY III
:?;
Total Inspections: - �` MY COMMISSION#FF118990
(Divide open by total to get%of open inspections) EXPIRES May 4, 2018
Percentage: (407)39"153 FloridallotaryServicexom
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee) ' C Ir I V ®
Revised 7/21/2014
OC r 3-11 2017