HomeMy WebLinkAboutPermit Renewals 06/13/2019 09:28 7726921094 PREMIER PAGE 01/02
PLANT WG AND DEVELOPMENT SFAVICES DEPA RTWNT
BUILDING ANI1 CODE REGUTATIONS DIVISION
2MO V1BlG'ilN1A AVE
IN FORT PMCE,FL 34982
(772)462-1553 Fax M 462-1578
RECEIVED
PERM'I'T RENE,VVAL REQUEST
JUN 13 6"'019
y� 4�,y - �y ...�(/yh/%�f (/p�(� }may[].//}�f) }y�{.� f}'/�f��/r7/�/1�/"� ron.",
T de County Per fitting
Lt+er' {rt end ►/ c
z,
requesting that the above permit be re e�ved_�I�
understand That I rust sc�attd pass all required iaspeCdons for the permit-to be finaled. Further, I
uraderstsmd that this is al �Itj and the permit shall cspiie should I not receive a
passing-mi spection. any six month period duriag-he renewal period.
Tusti;ication G�
-�
. QWNERfBLDROR CQIv'k�t.B.C'TOR SIGNATURE 17.P�TE
�rn A
Nat Mame .... ...�.�. ►_
. on�a�aoatsa
STA.TF-of
COUNTY OF : f f
ALCI�NOW GE,D BEFORE,ME'rnmww l 6-[A DAY OF c J��� ,20
BYF ON YltiQ4TY?1tiQE• QR
HAS PROVIDED
IDkI3 AS IDMr FiCATION.
STA-M OF FLORIDA,County O
S3 {3F
NOi a1F-
FOR OFFICE.USE ONLY.' ...�-
n urnbes of Open lnspeckiom,
Tort lwpections-
(Divide open by Wd to get%of ape¢inspe tiros)
Perrcentage-
Origirw pelxait cc t%open =*'$ Renewal fee
Example: [15 divided •$175(permit*c)x.63=$113.'75(renewal fee)
R-wivad 7/212014 -
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