HomeMy WebLinkAboutPermit Renewals (2) M
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
o BUILDING_AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1611-0233 ADDRESS: 7109 PLUMOSA LN
GARY WEST
I, ,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 Final inspection was never complete.
OWNER/BLDR JCONTRACTOR SIGNATURE DATE
Gary West
Print Name
I
STATE OF FLORIDA
COUNTY OF olzlq�C4t
ACKNOWLEDGED BEFORE ME THIS 31 DAY OF .J A v ,20_(l
BY 6�" WHO IS PERSONALLY KNOWN TO ME 1' OR
HAS PROVIDED AS IDENTIFICATION.
STA OF FLORIDA Coun of0 AA Abi K
SOP°W Notary Public State of Florida
rf
y . Billie Falkner
SEAL ��'►or M10 f Expires 9/06/2 22 246237
SIG ATURE O NOTARY �A y
------------------------------7-------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY:
V,--)Number of Open Inspections:
f 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