HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
® BUILDING AND CODE REGULATIONS DIVISION
s 2300 VIRGINIA AVE
-- --- - —- FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1707-0320 ADDRESS: 3880 N A1A #503
I, ,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
OWNE C NTRACTOR SIGNATURE DATE
RICHARD LEVINSON
Print Name
STATE OFF OW �
COUNTY OF DrOr
ACKNOWLEDGED BEFORE ME THIS _DAY OF Aly, I .20
BY R►chard Lev;nwri WHO IS PERSONALLY KNOWN TO ME Q OR
HAS PROVIDED AS IDENTIFICATION.
STA E F FLORID ,County of •, PATTIE JO NETTLES
:?•' :
MY COMMISSION#FF952984
SIG ATURE OFVOTARY SES �'oaEXPIRES January 21,2020
I4u71345.053 Fluw dallolaNSelvice cw�•
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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