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MANNING AND DEVELOI?�MW SERVICXS,"! EP Rx�T
BUILDW(;AND CODE REGULATIONS D71&T N
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(772)46'Z Fox Cr/2)461-IM �
IBM=RENEWAL REQUEST;
PEiZMIT NVMRM,l-606-"0 �AJDDRREEss:D zj�ra ���"L . dOR
I, am(requesting that the above permit be rrr>owed. I
understand that I must schedule and pass all requited inspections for the permit too;be fiinale& further,T
understand that this is a ONE X=,RE 'WAL and the permit shall e44re sfxctuld I riot receive a
possing inspection during any six month period daring the renewal period.';
' Justification l"1�J� � �
LDR R CONI'ttA, SIGNATURE DATE
' FzttrtzNam
S'T*Tg OF FLORMA
COUNTY OF P tit 66
ACMWLEDGET)BEFORE M>;THIS I RAY OF �-e e�-�Y i' gp l;
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• R x -1�iN n 1►1 II! r ♦ ` 'max��:i,`� WHO IS ri]3\i7ONALL{KNOWN TO 1.1,3
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ST TE OF FL0RJDA C=W0f: 0d. t --
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FOR OFFICE USE ONLY.
Number of Opett Inspections:
Total Inspections:
I
i (Divide open by total to get*A of open inspections)
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Original permit fcc: x%Open = S Renewal fee
. Rxample! VS divided by 23a,65M01 �' 5{pcaait fGe�x.65=S2 i3,7 (ser waLf c)(' �`
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