HomeMy WebLinkAboutMisc Letters From: 01/19/2018 11=23 #467 P_002/002
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: SLC 1701-0192 ADDRESS: 2601 ARNOLD CT
I, SAM OCHSTEIN '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 expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification FINAL INSPECTION
OWNER/BLDR OR ONTRACTOR SIGNATURE I DAT
Print Name
STATE OF FLOKID,A
COUNTY OF K10%
ACKNOWLEDGED BEFORE ME THIS�_DAY OF Arta r� 20A%—
.13Y C_ _ WHO IS P9R80N2XE=4AMWN TO ME��,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLOjtIDA,County of ibtw \ti1kach
e-"%- KIM A.STONE
SIGNATURE OF N�Y MY COMMISSION#FF926006
EXPIRES:October 15,2019
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(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014