HomeMy WebLinkAboutpermit renewal request PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
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- BUILDING AND CODE REGULATIONS DIVISION
- 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 RFS
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PERMIT RENEWAL REQUEST Pe� 11 ?�1B
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PERNIITNUMBER: 1710-0374 ADDRESS: 1408 N 42nd St
I, Raquel Swanner ,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 Conflicts with the customer's schedule prevented corrections from being made
prior to the permit expiring.
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O BL COR SIGNATURE DATE
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STATE OF FLORIDA
COUNTY OF si Lucie
ACKNOWLEDGED BEFORE ME THIS DAY OF Q ,2015�-
BY Raquel Swanner WHO IS PERSONALLY KNOWN TO ME_ !� OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
El-
TIMOTHY R.O'MALLMY COMMISSION11713SIGNATURE OF NOTARY SEAL EXPIRES:August 7,2021
Bonded Thru Notary licnderwriters
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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
In3-77(v7 d