HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
® BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)4624553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1811-0244 ADDRESS: 5811 Seagrape Dr Fort Pierce, FL
I, Arthur W Francis ,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 The inspections were not completed and we need this permit active so a final inspection can be scheduled and completed.
OWNER/BLDR OR Cr
TRACTOR SIGNATURE DATE
Arthur W Francis
Print Name
STATE OF FL DAJ QQ
COUNTY OF - i� 1 Cr
ACKNOWLEDGED BEFORE ME THIS DAY OF May 20 19
BI; Arthur W Francis WHO IS PERSONALLY KNOWN TO ME X OR
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HAS PROVIDED AS IDENTIFICATION.
S1. Ly a�rgs Ashley Raines
OF LO A,County of C ( Q1 �' NOTARY PUBLIC
!-!STATE OF FLORiDA
SIGNA OF NOTARY SEAL W F�Comm#GG235648
Expires 7/5/2022
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FOR OFFICE USE ONLY:
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Number of Open Inspections:
Total Inspections:
I (Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(1/o)] $175(permit fee)x.65=$113.75 (renewal fee)
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Revised 7/21/2014
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