HomeMy WebLinkAboutPermit Renewals 02/21/2018 16:16 Office (FAX) P.002/003
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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 V1RG1N1A AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST 11
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PERMITNUMBBR: SLC1610-0433 ADDRESS: 7501 MIRAMAR AVE, FT. PIERCE
I, am requesting that the above permit be renewed. I 9
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 inspectio uring any six month period during the renewal period.
Justification ' �-
OWt,FBLbR OR tONTRACTOR SIGNATURE DATE
JOSEPH HERRMANN
Print Name
STATE OF FLOI , ��
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS_ 51t"'DAY OF '�" 24 I
BY WHO IS PERSONALLY KNOWN TO MEZ _,OR
HAS PROVIDED AS IDENTIFICATION.
STATEA FLORIDA,County of GARGLE A P
AULSEN
MY COMMISSION Al FF901106
SIGNATURE OF NOTARY EXPIRES May 10,2020
N07 3ylt.p153 PbrdripN B�hIf�.Gonl
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(0/*)] SI75(permit fee)x,65=$113.75(renewal fee)
Revised 7/21/2014