HomeMy WebLinkAbout9417 S OCEAN DR 42_RENEWAL APPPLANNING 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: 1912-0090 ADDRESS: 9417 S OCEAN DR #42
1 RICHARD BASSOFF , 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 OWNER ONLY IN TOWN THIS WEEK NEED PERMIT RENEWED ASAP TO CALL FOR INSPECTION BY 6/12/20
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OWNERBLDR R TRACTOR SIGNATURE DATE
RICHARD BASSOFF
Print Name
STATE OF FLORIDA
COUNTY OF PALM BEACH
ACKNOWLEDGED BEFORE ME THIS 8TH DAYOF JUNE
By RICHARD BASSOFF
HAS
2020
WHO IS PERSONALLY KNOWN TO ME X . OR
of PALM BEACH
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
AS IDENTIFICATION.
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Notary Public State of Flonda
Jacqueline Georgesc�u
SEA y, ` My Commission GG 233: 00
Expires 06/2a/2022 .�'
Example: [15 divided by 23=.65(1/o)] $175(permit fee) x.65=$113.75 (renewal fee)
Revised 72M014