HomeMy WebLinkAboutPermit Renewal Request li
Fax:(772)462.1579 Page:2 of 3 07!0912019 9:39 AM
From:Mike He'sssenberg Fax:17726720990 To:
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINLk AVE
_.....:......................_ FORT PIERCE,FI..34982
(772)462-1553 Fax(".72)462-1578
PERMIT RENEWAL REQ`
PERMIT NtJ"vIBER; ( Ps L
.J 9 q ADDRESS; A ° [ ix 1 )
I, ` ! "d _ 1 ,am requesting that the above permit be renewed, I
understand that I must schedule and pass alYrequired inspections for the pert-nit to be finaled. Further, [
understand that this is a ON'E.TEME RENEWAI,and the permit shall expire should I not receive a
passing inspection during any six month period during theFrenewal period. 1�tt r �"j,j �
ustlfication r� 1 k •X!� l: t �C 1 } V
OWNIER/BLDR OR CONTI2 C'TOR SIGVA V DATE
Print Marne
i
STATE OF FLORID
COU\UY OF J. .ucc
ACKNOWLEDGED BEFORE ME THIS DAY OF _ ?U _
4-e WHO IS T F'RS0NALLY KNOWN TO'AE b' OR
HAS PROVIDED f ...,�_ —___._---........_.�_ AS IDI i+TIPIC.ATION.
'T'E .�'FLOFtI JA "oW�ty of �'�' `-�,"'�.. "�'' '�''"ed'w ✓�°rswm
Notary Pupife State of Ftorids
Heather Vitzo
.I g MY GommiasicA GG 262655
SIG IAT11RE OF NOTARY SEAL. o Expires t tlt3tZ022
--------------------------------------—---—-------—---------—--- -------------
F€R 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 Renewal fee
Example: (15 divided by 2)=.65(°.o)j $175(permitfee)x.65=$I 13.75(renewal fee)
Revised?121i2014
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