HomeMy WebLinkAboutPermit Renewal RequestbR- NoGo
Public Works Department
Code Compliance Division
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
PERMIT RrE�NEWA/L� REQUEST
ADDRESS:-%900rr/�./m�1�1PP�'C f/' PERMITNO.://D—O?loj
r
I, CT�' iZe ldl� .-AM REQUESTING THAT THE ABOVE
PERMIT IS RENEWED FOR EIGHTEEN MONTHS. 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.
, / (G,�_
OwnerBul er or Contractor Signature
STATE OF FLO DA
COUNTY OF . �-V �1iK
Sworn to and subscribed before me this 4� day of SO
by (3� Al i -A c� +�\ . Who is personally known
L. 1) L as identification.
Notary Public, Stt tf "f Florida
Signature of Notary:
Commission No.:EuolSK-j 6
FOR OFFICE USE ONLY:
RENEWAL FEE:
Q� &
Date
or who has produced
DEANNA GIVENS
Notary Public - State of Florida
My Comm. Expires Dec 16, 201C
Commission M EE 656761
Bonded Tbrouobdti110ed Notary Assn
OPEN INSPECTIONS ( ) X PERMIT FEE ($
TOTAL INSPECTIONS ( )