HomeMy WebLinkAboutRenewal request PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
TT-LUCI E.
•
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST Pei 45p.,
St 4 p
I/e/e cAo, gent
PERMIT NUMBER: 1709-0497 ADDRESS: 3520 RED TAILED HAWK DR
I, MARK A VINES ,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 PERMIT EXPIRED WITHOUT FINAL INSPECTION
14
Ik e�el
4/11/2018
OWNE LDR OR CONTRACTOR SIGNATURE DATE
MARK A VINES
Print Name
STATE OF FLORIDA
COUNTY OF PALM BEACH
ACKNOWLEDGED BEFORE ME THIS 11 DAY OF APRIL 2018
BY MARK A VINES WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE O GRID f PALM BEACH
•y, Notary Public State of Florida
Ap `� John Edward Gifford
SI OTARY ed'.s 1 /17/2ssion G1 14781 5
'C kes 121t7/2o21
of
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