HomeMy WebLinkAboutPermit Renewals ' PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34,982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST;
PERMIT NUMBER: SLC 1606-0238 ADDRESS: 3880 N HIGH W,, AY A1A APRT 701
am requesting that the II bove permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
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�e.�n-t' `I LoosX�S Inp ri
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0 4LEVINSON SIGNATURE DATE
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Print Name ;I
STATE OF FLO
i COUNTY OF�1Gte- i
ACKNOWLEDGED BEFORE ME THIS /L9 DAY OF'__0,eccr» &Y 1 20 17 !
BY 4�11CA^X:kra LeV{r18or1 WHO IS PERSONALLY KNOWN TO IME✓ 11 OR
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HAS OVI A IDENTIFICATION.
STAT County of ?Ly Pia it ShenekaHardy
Notary Public-State of Florida
SIG REO NO RY Commission#GG 33870
Ns, < Expires 9%27/2020
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FOR OFFICE USE ONLY:
4
Number of Open Inspections:
Total Inspections: + l
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75 (renewal fee) i
Revised 7/21/2014
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