HomeMy WebLinkAboutPermit Renewals PLANMWG AND DEVELOPMENT SERVIC" EPA �'1l+XENT
13uiLDI NG.ANT)CODE REGULAnQNS DxVIRON
. _ i300 u1C CWC AVE
FORT PIERCE,FL 34982 j
(772)461.1553
FaX(Tib 462-11SU
PER.MT RENEWAL RE, ST.. �
Rlv �r NUMBER., ADIDREss:S•
I, am requesting that the a"pexin t lac lremewe& I
understand that I must schedule and pass ail required mspectiaUs for the permit to be finaied. Further,T
• understand that this is a 'TIl►'IE RE vtraL and clue Permit shall C;K r6 siloU11d I no,'t receive a
pissing inspection during any six month period dunkg the renewal period.
Justification AJA
LDR OR MN--TPACTf SIGNATURE DATE 11
Pjint N=e
ST Tp OF FLOaf17A.
COUNTY OF P ITme'A 06 '
i I
AMMWL.EDGED BEFORE NE T M9 4 DAY OF
Earkk9kC-WFj0 IS PERSOMLI.Y KNOWN TO NITS V' I.OR
HA3 FROWDED AS 1A jE�I P[II�CA7'fON.
ST TE OF FLORIDA,County of ( S
40M.% SE
My�{ ION91,5441
SIGNATURE OF 'GARY 86AL � � �` EXPIRES:.lanua��1Y,.S�,2bP6
• j Ij
FOR OFFICE USE ONLY:
Number of Open.inspections:
ToW Inspections:
(Divide open by total to get%ol'opea inspeetiuns)
Original permit fcc: x%open = Renewal fee
Fwmplee CIS divided by 23-.650/01 $175(permit N)x.65=$113.75(remvml fec)II
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