HomeMy WebLinkAboutPermit renewalPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• LBUILDING AND CODE REGUA r rw OS r,I v ISION
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(I -IL) 462-1553 i'aa (772) 462-15711
PERMIT RENEWAL REQUEST
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1, Dennis zdueR , am requestin, that the abz;vc permit be rem;wLd. I
understand that 1 muse schedule and as3 all r<,quired inspecticna for the permit to be f maled. Furthrl. I
understand that this ;a u ONE TIME RENEWAL and the permit shall expire should I not reixive a
passing inspcctiun during any san month period during the renewal petiud.
Justificat;un Permit E.&pired
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Dennizi ZaGek
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51 A It Ur rLOKIDA
Cuury 1 r Or si _U iu. cvanl
/- C&NlwLCllGtll bV-r0Kt. ML IHls C� DAY (3r' {.tf , 20—L�',Q
BY R 1 UT)EEL k WHO IS PERSONALLY KNOWN TO tno Mr,
HAS PROVIDED Drivers License A3Mm-iii7ji-4.
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K1q , County or �1 �U�,l�, QU MELISSA CHATEAUNEUF
Stato of Foria.. -Dote.—, Pe61ia
Commission # GG 340178
SIGNATURE OF NOTARY SEAL M, C,.mmission Expires May au, zuzS
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Di amide open by total to geL % of open inspections)
rercentase:
Orir,inal permit fee: x % open = $ Renewal fee
Example: [15 divided by 23=.6j('/.)] Si ,,(permit ice) x .8.3=z51trenewal teed
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