HomeMy WebLinkAboutPermit Renewals PLANNI:TG AND DEVELOPMENT SERVICES DEPARTMENT
COUNTY BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-157$
PERMIT RENEWAL REQUESC
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I'ERMI'C NUMBER: SLC 1610-0201 ADDRESS: 1103 OCA1 A AVENUE FORT PIERCE, FL 34951 er�h��879
I AMERICAN RESIDENTIAL SERVICES 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 INSPECTION FAILED NEED TO RENEW PERMIT TO HAVE REINSPECTED
TO CLOSE FILE OUT
OWNER/BLDR OR COWRACTOR SIGNATURE DATE
Print Name
STATE OF FLORIDA
COUNTY OFG�^^
ACKNOWLEDGED BEFORE ME TH1S v2 3 DAY OF .20
BY b-e—n r i S Z el, c e- WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STAT FFLORIDA,Cou of v~ S IA A/ �t�C� """" CRISTY LIGHTSEY
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"? Convniss+on N FF 929045
Cummt
Si ATURE OF Y SEAL My October
20, 201 9 s
%;"���";�''e C)C10ber 20, 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 — $ Renevat fee
Example: [15 divided by 23=.65(%)] $115(permit fee)x.65-$113.75(renew-Al fee)
Revised 7/212014