HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982 RECEIVED
(772)462-1553 Fax(772)462-1578
DEC s
PERMIT RENEWAL REQ SX, LuGIt�CUUM-y, 14-�rmittina
PERMIT NUMBER: 1812-0021 ADDRESS: 10701 S OCEAN DR 816,JENSEN BEACH,FL 34957
I, CHRISTOPHER SHAW ,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 NEED TO CLOSE OUT PERMIT ASAP
� - IL - 1 -z0Iq
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
CHRISTOPHER SHAW
Print Name
STATE OF FLO IDA
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 1\{01S'Y,►e ,201 9
BY f WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FL D� �C;.�.
(:::�r I k � =oar P`e�r Notary Public State of Florida
GESELLA
SIGNATU OT Y SEAL Q My Commission GG 151455 a55
oF,vZ Expires 10/15/2021
FOR 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 fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014