HomeMy WebLinkAbout1410-0110.4"PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
]BUILDING AND CODE REGULATIONS DIVISION
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,PERMIT RENEWAL REQUEST
Oil 6 ADDRESS:
1, Ztly (3 1 tu , am requesting that the above permit be renewed. 1
that I must scSAle and pass all.required inspections for the permit to be finaled. Further,1
that this is a T TIM—R-EMWAL and the permit shall expire should I not receive a
nspectoa.d -
ynng any six month period during the renewal period,
•
PEF
understand
and
ersmd
passing
Justification --V1f7kS
OWNER/BLDR OR CONTRACTOR SIGNATURE
K, M
Print Name
APRLBRMW
CataTil"M208194
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Ev.
STATE OF FL)DRID
A 4e
COUNTY OF /5411DAY OF 204:� A�XNOWLEDGEDBEFORAME THIS BY Kim sa-) — WHO I90g��TOME _,OR
HAS PROVIDED AS IDENTIFICATION.
FOR OFFICE USE ONLY: -
..Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage: z .. .. 1.
Original permit fee::_ x% open S .Renewalfee
Example: [L5 divided b;)�1.3=;.65(3W)." (renewal &,--)
Rey=d 7121/2014
No