HomeMy WebLinkAboutRenewal request From 1.877.233.3839 Thu Dec 26 10:54:16 2019 PST Page 2 of 3
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
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2300 VIRGINU AVT;
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1906-0350 ADDRESS: 3805 South Indian River Dr,Fort Pierce,FL 38492
I, Thu Npi3,Pn , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be flnaled. Further, I
understand that this is a ONE TIME RENEWAL and the pemiit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification Permit expired while awaiting inspection;initial inspections failed because inspectors could not find
our permit papers while they were on site,need permit renewed to reschedule inspection.
OWNERBLDR OR CONTRACTOR SIGI\ATURE DATE
Thu Nguyen
Print 1\acne
STATE OF FLORIDA
COT JNTY OF
ACKNOWLEDGED BEFORE ME THIS `DAY OF ��Z ,20—/'�F
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BY WHO IS PERSONALLY KNOWN TO MF, OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA.County of
SIGNATURE OF NOTARY sr.ar_
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)
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