HomeMy WebLinkAboutPermit Renewals 12/11/2017 18:06 1 ELITE ELECTRIC INC PAGE 02
PLANNING AND DEVELOPMENT SERVICES DEPARTM ENT
•
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST J ��
�O
PERMIT NUMBER: 1701-0030 ADDRESS: 7415 Silver Oak Drive
I John A Pankraz ,am requesting that the above permit be renewe • 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 rece ive a
passing inspection during any six month period during the renewal period.
Justification customer has cancer and had to go up north for treatments, said he would call when available
12/13/2017
OWNER/BLDROkCONTRACTOR SIGNATURE DATE
John A P az
Print Name
STATE OF FLORIDA
COUNTY OF sax,i wd•
ACKNOWLEDGED BEFORE ME THIS 13th DAY OF December ,2017
BY John A Pankraz WHO IS PERSONALLY KNOWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
STATE,RF FLORIDA,County of Laint Luc!
NANCY L ;LANGFORD
SIGNATURE OF NOT Y SEALa MY 1001 s ,IN 002 072
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(1/1o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014