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PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
111 i l BUILDING AND CODE REGULATIONS DIVISION
s+ 104 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
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PERMIT RENEWAL REQUEST
PERMIT NUMIIER: °aJ 0 ADDRESS: M13 Uoyntb D Rkrerc i
I Michael Sonsini ,ain requesting that the above permit be renewed. I
understand that I iaiust schedule and pass all required inspections for the permit to be finaled. Further;I
understand that this is a ONE TIME RE,NEWAL.and the permit shall expire should I not receive a
passing inspection'during any six month period during the renewal period.
.111stiiication�1 %, (I,t►ti{, �� 0 Q•{,y-
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OW NE1 Iil.DR OR CONTRACTOR SIGNATURE DTE
Michael Sonsini
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STATE OF FLORIDA
COUNTY OF St.L-ie
ACKNOWLEDGED BEFORE ME THIS q _ DAY OF .20 20
BY Michael Sonsini WHO IS PERSON YKNOWNToME X ,OR
I1A5/['tOVIDI"D AS IDENTIFICATION.
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S-1 ofLO1 rA 'ni itvF
- • St Lucie
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mycomms"ION3i002923x0
was: f
'�p!,I,,••• BondedThruNot�f►t?�CUndmunipts
FOR OFFICE USE ONLY:
Nutnbcr of Open Inspections:
Total Inspections:_
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = S Renewal fee
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Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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