HomeMy WebLinkAboutHarrison- Permit Renewel RequestPLANNING 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: 1909-0609 ADDRESS: 1318 White Oak Lane
1, Larry Neese , 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
5/11 /2020
SIGNATURE DATE
Neese
Print Name
STATE OF FLORIDA
COUNTY OF &! -
ACKNOWLEDGED BEFORE ME THIS —l. DAY OF 1" A y 20-0
BY 1 drt'v %1Getse- WHO IS PERSONALLY KNOWN TO ME , OR
Or
HAS PROVIDED — AS IDENTIFICATION.
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STATE OF FLO DA, County f 's� r� i e.Yb'"•., MICHAELV KING
Notary Public State of Florida
Commission # GG 205106
S1 OF NOT S 0, r tti My Comm. Expires Apr 9, 2022
Bonded through National Notary Assn.
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