HomeMy WebLinkAboutRenewal formPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: SLC -1710.0585 ADDRESS: 802 Nettles Blvd, Jensen Beach, Fl-
I,
LI Robert Diedrich , am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be funded. 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 completed in one day and we never ordered an inspection. It was
an oversight and we'd like to be able to schedule the inspection vL�
7/17/20
ON�' xR1 L RUR CUN I RAC-rOR SIGNA'T'URE DATE
Robert Diedrich
'rird Name
STATE OF FLORIDA
COUNTY OF;jx2h M. f i Aw
ACKNOWLEDGED BEFORE W THIS 1"71% DAYOFJAy 2e Z6
Ap
BY za3))j1,, WHO IS PERSONALLY KNOWN TOME OR
HASPROVIDED fL DL AS IDENTIFICATION.
/S/T,g'TEOFFL RIDA,Countyofsrnoit.,` (Ztvf
CJJ1✓J 1` /
nR'iNA9TJRE OF NOTARY'.,,w DAVID M ONIN
SEAL -: *.n-
MVXPIRES w pG,2021
EXPIRES January 26, 2021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original pemdt fee: x %open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(pemtit fee)x.65=$113.75 nenewaT Yee)
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