HomeMy WebLinkAbout1 LAKE VISTA TRL 205_PERMITRENEWALPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
PERMIT RENEWAL REQUEST
PERMITNUMBER: 1812-0286 ADDRESS: 1 Lake Vista Trail, 205
I Richard Bassoff , 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
Homeowner was out of state and unable to get access to home for inspection
1 ���i—�; j►I
OWNER/BLDR OR C&fRA97 SIGNATURE
RICHARD BASSOFF
Print Name
STATE OF FLORIDA
COUNTY OF PALM BEACH
ACKNOWLEDGED BEFORE ME THIS 08
BY RICHARD BASSOFF
HAS PROVIDED
ST F FLORIDA, unty of PA B
� � t
SIG ATURE OF N6TARY
FOR OFFICE USE ONLY:
DAY OF October
10/08/2019
DATE
2019
WHO IS PERSONALLY KNOWN TO ME X OR
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permit fee: x % open = $ Renewal fee
AS IDENTIFICATION.
NICOLE M SULLIVAN
MY COMMISSION # GG043125
'?oF N EXPIRES October 30, 2020
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014