HomeMy WebLinkAboutPermit Renewals AMIRM PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE —� £:t Itl�Vp
FORT PIERCE,FL 349#2
(772)462-1553 Fax(772)462-1578 M�4Y
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PERMIT RENEWAL Ri41f1E _f2 _y, p�rmi (
PERMIT NUMBER: SLC-1910-0100 ADDRESS: 6789 S. Indian River Drive, Fort Pierce, FL 34982
I, Travis Haag ,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 Due to the Covid-19 Pandemic and external factors I was not able to
Complete the building in time to allow for Electric service to be connected to the building.
��`z��►..�a �� 05/18/2020
OWNER/BLDR OR CONTRACTOR SIGNATURE DATE
Travis Haag
Print Name
STATE OF FLORIDA
COUNTY OF S>r-
ACKNOWLEDGED BEFORE ME THIS DAY OF ,20 a
BY WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, unty of k' r�"�,'S,n DEANNA MARIE GIVENS$
MY COMMISSION 9 GG 022023
EXPIRES;December 16,2020
SIGNATURE OF NO ARY Bonded Thru Notary PubIi;]yp grw6ters
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