HomeMy WebLinkAboutPermit Renewals PLANNING 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
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PERMIT NUMBER: 1907-0328 ADDRESS: 505 N 39th ST FT. Pierce FL
I, Roderick Waller ,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 Home Owner was out of the County
01/31/2020
OWNER/BLDR OR CONTRA OR SIGNATURE DATE
Roderick Waller
Print Name
STATE OF FLORIDA
COUNTY OF St.Lucie
ACKNOWLEDGED BEFORE ME THIS 31 st DAY OF January 2020
BY Roderick Waller WHO IS PERSONALLY KNOWN TO ME XX OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
4?0 S"hryaHam Stop of Florida
SIGNA RE OF NOTARY SEAL
� Expires pMy r,0Mrnia3i*n 20 238873
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
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