HomeMy WebLinkAboutPermit Renewal To: Permit Division Attn Ellen Page 2 of 2 2019-01-02 18:18:04(GMT) 17722063146 From: Holly Kulinski
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PLANNINGAND DEVELOPMENT SERVICES•DEPARTMENT
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DUILDLNG AND CODE REGULATIONS DIVISION
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PERMIT RENEWAL REQUEST st; t19 1
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PERMITNUMBER: 1806-0112. ADDRESS:- 1491 $1/V. Sweetboy Cir
Thomas Kulinski
• , requestingthat the above permit be renewed. l
understand that I must wheduleand pass all required inspections for the pertnit to be fmaled. Further.
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receiVe.a ' •
passüg.inspection.during any six month period:during the renewal period.
justification GustQner was Out of Town-
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VNINIP,1641:,151'r.0g:C6WCIACTOR:SIGNATURE DATE
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Print Name
STATE:OF:FLORIDA,
• COUNTY or cujeTt,o;
ACKNOWLEDGED BEFORE ME hitS d DAY OF 4)C1c1,,,\Y\L-1,A, .20,
1W 1 A.‘CX.', \13„)‘!,ry-iic WHO IS PERSONALLY KNOWN TO ME OR
• HAS Pt AS IDENTIFICATION.
S(TOArs,TEr OFFORIDA,tCou
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4%44, Nt•laiy•Public Siete. 6.rnerida •
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SJG..kTt RC F: 01 \.R SEAL ,11 MrCQr t1824
I Expires O42/O2
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FOR OFFICE OW ONLY:
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Numher of Opon.hispeetions:
Total inspections:
(Divide open IDY.lei4i to ger:i7-71 open inspections) • • • • •..• •• •
Percentage.:
Original permit fee:- x%open. --= $ Renewal fee
Example:. [1.5 divided.by 23=.65(%)l 5.1.75(pecinir fee)x.65=541.3.75(renewal:fee)
Revised 712112014
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