HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BU>(LDING AND CODE REGULATIONS DIVISION-
2300 VIAGMA AW
FORT PMACA FL 34982
(772)462-1553 Fax(772)462-1578
PERMT RENEWAL REQUEST
FERWrWLTIMFM 1901-0422 ADDRESS: 9412 Poinciana Ct
Michael Coleman ,am requesting that the above permit be renewed. I
uuderstand that I must schedule and pass all required inspections for the permit to be finale& Further,I
understand that this is a ONE TIME RENEWAL Awad the permit shall expire should I not receive a
passing inspection during any six mouth period during the renewal period.
Justification Needs final inspection
11-20-19
OWNERIBLDR OR CONTRACTOR SIGNATURE DATE
Michael Coleman
Print Name
STATE OF FLORIDA
COUNTY OF�f-r
ACKNOWLEDGED BEFORFs UZ TLUS DAY OF kQ V 24
19
BY WHO IS PERSONALLY KNOWN TO ME ---AOR
iNA
RO AS IDENTIFICATION.
P it1DA,Cousxty o;f
AA
T Y SBAL
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Jmspections:
(Divide open by total to get%of open inspections)
Pm=tagc:
Original permit fee: x%open �- $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(pewnit fee)x.65=$113.75(renowal fee)
Revised 9/21/2014