HomeMy WebLinkAboutPermit Renewals _ PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
T BUILDING AND CODE REGULATIONS DIVISION
,COU ` 2300 VIRGINIA AVE
WE G, die•it ..,54
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: 12 %-rs ADDRESS: "3523 JUS i P.L_1 FL sc(
I, -L 1Ns gee C,r+
E S :JS ILLC_—,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` e-1�during any six month period during the re wal period.
Justification ft \. - s v o t i)1.,-e- v .---_ : t VJ JE t 1
C ccxf\m�st�s ESS vle&-ex . - tri �A�SS -
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O Lji`o R ti ' i'TRACTOR SIGN. URE DA E
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Print Name
STATE OF FLORIDA
COUNTY OF ,5 LOC(e,
ACKNOWLEDGED BEFORE ME THIS, 51(17?)AY OF crl [ a ,20 19 it
BY --3a Cfl.6 ` lQ39t`'' )WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED I • J �CI AS IDENTIFICATION.
STATE OF FLORIDA,County of S+(Wk_CA-A---'
S ELLEN VAUGHN
.��PY PVB,
SIGNATURE OF NOT Y SEAL _*° it State of Florida-Notary Public
*_ Commission #GG 270079
'%', oil\o' My Commission Expires
October 22 2022
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) i
Revised 7/21/2014
41114 ELLEN VAUGHN
1� UB4
:° a 1,;_State of Florida-Notary Public
*_ Commission #GG 270079
%?triol,`o`,, My Commission Expires
October 22, 2022