HomeMy WebLinkAboutpermit renewal request 5617961881 C e Ll U U�v a L/Iv l ✓1 09:53:20 09-21-2018 1 /2
Vl 1
l PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fox(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1704-0477 ADDRESS: 5216 PALM DRIVE
1, Christopher Andrews '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
SME4�RJALDM CONTRACTOR SIGNATURE DATE
Christopher Andrews
Print Name
STATE OF FLO01'h
COUNTY 01
ACKNOWLEDGED BEFORE ME THIS <::�( DAY OF ./kl2L�e i— 20�
B Xl TD�tC✓ G[ .S WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED f U c v} L(C.cx.c_. AS IDENTIFICATION.
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EA-r:,
LISA M.GRIMPE
Camrtriss1m#FF906612
SIG TURF NOTARY SEAT �August 4,2019 r�ci
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 721/2014