HomeMy WebLinkAboutPermit RenewalPLANNING 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: 1911-0544 ADDRESS: 195 SE SERENATA CT
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 NEED TO RENEW PERMIT ASAP TO CALL FOR FINAL INSPECTION AND CLOSE PERMIT
d:21o�z�
OW14R BLDR R
�rICTOR SIGNATURE
RICHARD BASSOFF
Print Name
STATE OF FLORIDA
COUNTY OF PALM BEACH
ACKNOWLEDGED BEFORE ME THIS 9TH DAYOF JUNE
BY RICHARD BASSOFF
HAS PROVIDED
FOR OFFICE USE ONLY:
6/9/20
DATE
2020
WHO IS PERSONALLY KNOWN TO ME X , OR
PALM BEACH
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.
.40 Notary Public State of Honda
Jacqueline Georgescu
My Commission GG 233150
SEALpA� Ezpire506/28/2022
Example: [ l5 divided by 23=.65(%)] $175(perrnit fee) x.65=$113.75 (renewal fee)
Revised 7/212014
COUNTY
F
L
O R
I D A
PLANNING 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: 1911-0544 ADDRESS: 195 SE SERENATA CT
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 NEED TO RENEW PERMIT ASAP TO CALL FOR FINAL INSPECTION AND CLOSE PERMIT
d:21o�z�
OW14R BLDR R
�rICTOR SIGNATURE
RICHARD BASSOFF
Print Name
STATE OF FLORIDA
COUNTY OF PALM BEACH
ACKNOWLEDGED BEFORE ME THIS 9TH DAYOF JUNE
BY RICHARD BASSOFF
HAS PROVIDED
FOR OFFICE USE ONLY:
6/9/20
DATE
2020
WHO IS PERSONALLY KNOWN TO ME X , OR
PALM BEACH
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.
.40 Notary Public State of Honda
Jacqueline Georgescu
My Commission GG 233150
SEALpA� Ezpire506/28/2022
Example: [ l5 divided by 23=.65(%)] $175(perrnit fee) x.65=$113.75 (renewal fee)
Revised 7/212014