HomeMy WebLinkAboutPermit Renewals 06/13/2019 10:09 7726921094 PREMIER PAGE 01102
rLANNING AND DEVELOPDOM SERVICES DEPARTMENT
BUILDING AND COIDE REGULATIONS DMSION
23WVikG1NUAvE RECEIVE
r rURCE,FL 30sz
(772)462-ISS3 Fax M 4fi2- 578
JUN 1 3 2019
PERWr RENEWAL RE 1�'E to County, Permitting
am requesting that the above permit be rename d. I��'�
understand that I must sche&le and pass 4 requh-W jspecdons for the permit-to be finaled- Further, I
understand that this is a ONE IM' M RENEWAL and tbo permit SbaR expire should I not xeceive a
assi inspection dudug any six month periodda ' tha renewal �o
Iustiiicatian "
OW NM'BS OR QR CONTRACTOR SJOVATURE � SATE
Nut Xame
�a�{�62o3i84
STATE OF FLOR A
COUNTY OF
AGKNOwI EDGED BEFORE-ME THIS-E tDAY OF
13Y _. '6Yt14ONALI St T�v'L) iIYT M .OR
HA.SPR.OVD7ED AS11DEM FTC•ATION.
] �STATE OF FLORiUA,County of__.�� .
! _ OF N T- czar"
FOR OFFICE.'USE ONLY:
Number of 0peu InVec'tions-
Total lubpectrons•
(Divide open by total to get%•of oro' Wsioections)
Peecepinge• .�,,..,_ ..
tlrigix4 permit fcct_..�T _r,114.opcn " $ _—.'mc w 1 fee
Example. .$175(permit fee)x-6:+=$113.75(renewal fee)
ttevis*a'7121)2014