HomeMy WebLinkAboutBuilding permit application PLANNING AND DEVELOPMENT SERVICES.DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGr1*4A AVE
_... _._ FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: 1701=0098ADD>zEss: 901 N.E. PRIMA VISTA BLVD.
L MARK WEBER
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 AN OVERSIGHT
6/10/20
OWNERIBLDR O CONTRACTOR SIGNATURE DATE
MARK WEBER
Print Name
I '
STATE OF FLORIDA
COUNTY OF BROWARD
ACKNOWLEDGED BEFORE ME TIIIS 10 DAY OF JUNE 2020
gy MARK WEBER WHO IS PERSONALLY KNOIWN TO ME X OR
HAS PROVIDED AS IDENTIFICATION.
STATE. F O CountV'of BROWARD"
dOCELYWE M VITELLA
MY COMMISSION#GG085656
cil
OF N TARY SEAL �-"r* EXPIRES March 22.2021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(.Divide open.by total to get%of open'inspection)
Percentage:
Original permit fee: x%open $ Renewal fee
Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014
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