HomeMy WebLinkAboutPermit Renewals 04-03-'20' 13:51 FROM- -7722837540 - T-386 P0001/0002 F-948
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
]BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE;FL 34982 FAPR
(772)462-1553 Fay(772)462-15.19EI ��
PERMIT RENEWAL REQUEST 7 ?..020nty, Permitting
PERMIT NUMBER:. 9t)6-0043 ADDRESS: 12038 riverbend rd.
I, Justin Poma ,am requesting that the above permit be renewed. I.
understand that I must schedule and pass all required inspections for the permit to-be fiinaled. Further,I
understand that this is a ONE TIME RENEWAL and the permit shall expire should l not receive a
passing inspection during any six month period during the renewal period..
Justification P rmit expired due to miscommunication with 5FWMD. I was told when.I closed permit with
?io d have closed at county.
them that my erim
4/3/2020
OWN R43LD CONTRA OR SIGNATURE DATE
Print Name
STATE OF FLORIDA--44
COUNTY OF 'MO�Y`Tt ti(1
ACKNOWLEDGED BEFORE ME THIS DAY OIC 14Zri 20aa_
B'1''��-[1 �� WHO IS PERSONAL LY KNOWN TO ME .OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
v"' AMY l:P"ENotaryPublic- ofRoOdaCommission 162603S1GNA II T 3EAL :My Comm.Expiov 21,2021Bonded bough NNolaryAssn.
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FOR OFFICE USE ONLY.-
Number
NLY:Number of Open Inspections,
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage: ,,��ii�Lb
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permiitfee)x.65=$111.75(renewal foe)
Revised 7/21/2014