HomeMy WebLinkAboutMisc Letters 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 1612-0198 ADDRESS: 8138 MEADOWLARK LANE
Matthew Kuntz ,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 Turing the renewal period
Justification Preform Final Inspection
11/3/2017
OWNER/1313DRORCO CTORSIGNATURE DATE
Matthew Kuntz
Print Name
STATE OF FLORIDA
COUNTY OF Petm Baac+
ACKNOWLEDGED BEFORE ME THIS 3rd DAY OF November 2017
BY Matthew Kuntz WHO IS PERSONALLY KNOWN TO ME X ,OR
HAS PROVIDED AS IDENTIFICATION.
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O O ST►R I 1 AS1a1 .1 ce SEAL
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FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(°/a)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014