HomeMy WebLinkAboutMisc Letters 04-09-18;22:20 ;From: To:7724621578 ;7724618722 # 2/ 3
,4;� :: - , ,•�,,;<:.;,.,,,,. PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
« 2300 VIRGINIA AVE
FORT PIERCE,M 34982
(772)462-1553 Fay.(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1 Z-t5 ADDRESS:-.6oS!9 1 _1 .1 "7 f�L1 mm
Ila prux ,am requesting that the above permit be renewed. I
understadd 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 CI�IS-t oven 1nl G1.S c�,� rSF -fin 1n(�r1 ���,1, rt 64
M
OWNER/ DR OR CON RACT SIGNATURir DATE
Print Name
STATE OF FLDAA
COUNTY OF f J Q
ACKNOWLEDGED BEFORE ME THIS V DAY OF
�-�s ►�, s
WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
S TE 0 LQRIDA,County of
h ={ CHRISTINECtiLPEPPER
SI • ATURE OF N •ARY SBAL �: .., MY COAlMISSION sa GG 061784
°
A: EXPIRES;January 11,2021
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-______�_----- -------------- .«.,.••-------------
FOR OFFICE USE ONLY:
Number of Open Inspee6ons:
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)
Reviscd=1014