HomeMy WebLinkAboutPermit renewal From;Mike Heissenberg Fax;17728710990 To: Fax;(772)462-1578 Page:2 0.2.. 0610112020 2:45 PM
.,. x �esz, PLANNING AND DEVELOPMENT$ERVICES DEPARTMENT
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BUILDING AND CODE REGULATIONS DIVISIONA
2300 VIRGINIrl.AVE
I
- _ •__ j10E,FL 24962
15
FORT PIE
.(772 462- 5..3 I&.x(17). 2-.157!3. .
PERMIT RENEWAL RE'Q?[.iI ST
PEWITM.JMBEk' -AD KESS, a, t CIRIM 4 o ►1141 _.�I . .. ``
am requesting.that the shove permit be renewed. I
kinderstand that I trust schedule add pass all-required inspections-far the pertmit.to be finaled{ Further.:.
understand that this is a ONE TIME IC,NEWAL an the permit shall expire.should�r�o�receive a..•
passing inspection cl'unrAirl any six monthperiodcl(urinc,the renewal period,
:Justification V Y Y!� W iL ����_.-
—� - .
•
j
'-OWN I l I,I R.QR
COs TOR Str .A pArE
�'rint;Marne - "
STATE OF FLORLDA
COUNTY
ACKNOWLEDGED BEFORE,ivET1j1S � __DAY OF
BY" � 14� i L� Tfls� WHO FF,1%.5.0\r1,LLY.1SN0'AVN TO ME OR
`.HS.:PRQVIDFB __ _--M, .. . AS 11�.C'NTCFIC.. I IO�.
STATE Of FL QR:11?A,County of
`raylor O'Brien
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SIGNATURE OF N. TAR Y.
h10TARY PUBLIC .
JT
ATE OF FLORIDA
z . Comm#GG358999
Expires 2t1712024
FOR OFFICE USE ONLY: '�....
Nurnber of Open Inspections:
'.'Total Inspections; . .................................. ...............
{Divide open by total to get%of:open inspections)
Tercentage: .................... .................
Or.(ginal perrnit.fee: x%open M' S. Renewal fee
F..Xample: (l S dJv-idcd key Z.3=165(%)] �115(perxn t fee)x.65=x.11�.,?5{refacwal fee}
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