HomeMy WebLinkAbout1409-0231Jun 10 20, 09:32a Treasure Coast Roofing 7723438358 p.2 )
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
13UILDING AND CODE REGULATIONS DIVISION
• _ 2300 VIRG[NIA AVE
FORT PIERCE, FL 34982
(772) 462-I553 Fax (772) 462-1578
PERMT RENEWAL REQUEST
PERMIT NUMBER: fC4 D 9— 03.31 • ADDRESS: Igo .5G Yx%c er AUe-
1, Y, '+ n F 0' `j am requesting that the.above permit be renewed. I
under -stand that i.must schedule and pass all required inspections for the permit to be fnialed. Further,I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passim inspection during'any six month period during the renewal period
Justification
OR`NER/ LD ORC TR OR -SIGNATURE
/,�ti Gn /yA to n2r/
Print Name
Wgld-o,
DATE
STATE OF FLORI A
COUNTYOF SJ, LU�� /
ACKNOWLEDGED BEFORE ME TIES ID DAY OF �UPt-•P • 20�_
BY 1-2)vja" 1461,1jlriWHO IS PERSONALLY KNOWN TOME SG . OR
}IAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA, County of 5— "e i G
SIGNATURE OF -NO "I'ARY ,SEAL
-9-1-I (!�
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(permitfee) x.65=$113.75(renewal fee)
Revised 7/2t.2014
osoTPrhP NooU ry Pubic SI aof Rolm
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Ny Commission GG 274282
tea, rt°° expires tS.r0512022
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