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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
- -- FORT PIERCE,FL 34982 I i
(772)462-1553 Fax(772)462-1578 j
PERMIT RENEWAL REQUEST
PERMIT NUMBER: SLC 1704-0289 ADDRESS: 9421 S OCEAN DR# 91
I, Allen Steinman ,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 expirii"should I not receive a
passing inspection during any six month period during the renewal period.
Justification Property was vacant
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OWNS LD O CONTRACTOR SIGNATURE DATE
Allen �nma� i
Print Name
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STATE OF F ORI j I
COUNTY OF ''�
ACINGED BE ME THIS �1 DAY OF ean" I 29 �3
Q�/1</'Y)Ai'1 i
BY WHO IS PERSONALLY KNOWN TO ME '� � ,OR
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HAAS IDENTIFICATION.
STAI ounty of I'
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I , ! Sheneka HaIrdy
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S ATURE OF NO ARY �► ° Et�citary Public-State of Florida
N Commission#GG 33870
Expiri I9/27/2020
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FOR OFFICE USE ONLY:
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Number of Open Inspections: j
Total Inspections: I I"ny
(Divide open by total to get%of open inspections) j
Percentage:
Original permit fee: x%open = $ Renewal fee i
Example: 15 divided by 23=.65(0/o)] $175(permit fee x.65=$113.75 renewal fee) I I
Revised 7/21/2014
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