HomeMy WebLinkAbout1906-0301 Renewalr
NTY!t
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
PERMTr NUMBER 1906-0301 ADDRESS: 1350 HARTMAN RD
1 RONALD KINDEL , ani. Tequesting 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 WORK WAS NOT COMPLETED
OWNER/BLDR OR CONTRACTOR SIGNATURE
RONALD KINDEL
'Tint Name
STATE OF FLORIDA
COIJNI'Y OF i
6/812020
DATE
ACKNOWLEDGED BEFORE ME THIS DAY OF ry-e T 20 �c)'
BY �l¢���i1 c� C� �I WHO IS PERSONALLY KNOWN TO ME , OR
HAS PROVIDED �� L �lh, �1 1 3 l (p k 4S i 0 ^� AS IDENTIFICATION.
TE OF FLORIDA,
1C'
:�_jy-u-�-�
�.� ,.L DpNNA PADlil.A
SfGRAXUP"F NOTARY - SEAL r•� Notary Public, State of Florida
ComrniSSion# GG 315538
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 T2112014