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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
# BUILDING AND CODE REGULATIONS DIVISION
• 2300 VIRGINIA AVE
_.. ___w_...._____.._ ._.__._.._._._........ FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1711-0670 ADDRESS: 2402 Blossom Ct. Fort Pierce, FL 34982
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 Delays in material availability caused permit to expire prior to installation
D R CTOR SIGNATURE DATE
R el Swanner
Print Name
STATE OF FLORIDA
COUNTY OF sTLude
ACKNOWLEDGED BEFORE ME THIS ,*3 DAY OF 4�t}?zl"fv 54- 12018
BY Raquel Swanner WHO IS PERSONALLY KNOWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
A,Co St Lucie
Jonathon Thomas
5ZOFOTARY : o NOTARY PUBLIC
—STATE OF FLORIDA
Comm#GG141189
_-------------- --� g!1 812021
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
Revised 7/21/2014