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
PERMIT NUMBER: 1803-0457 ADDRESS: 5005 FORT PIERCE BLVD, Fort Pierce
Roderick Waller
I, ,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 Customer had health issues
46A A lei)cj� 3/26/20
OWNER/BLD OR CONTRACTOR SIGNATURE DATE
Roderick Waller
Print Name
STATE OF FLORIDA
COUNTY OF St Lucie
ACKNOWLEDGED BEFORE ME THIS 26th DAY OF March 2019
BY Roderick Waller WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLO DA,Co n f St Lucie
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of Florida
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SIGNA . OF NOTARY S z36e73
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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