HomeMy WebLinkAboutPermit RenewalJun 10 20, 09:32a Treasure Coast Roofing 7723438358 p.4
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
S J = BUILDING AND CODE REGULATIONS DIVISION
e _ 2300 VIRGINIA AVE
FORT PIERCE, FL 34992
(772) 462-15S3 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMITNUMBER: IGIa--'0399 ADDRESS: 1158y J5Sn IC
I Y,1 G19n 042 jnng 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 M - Z ao f R j? icy -!a t g't' i
OWNE BL ORCO.�;TAC SIGNATURE DATE
Ign-0, /la1d4e
Print Name
STATE OF FLORIDA j, uGZ
COUNTY OF SX
ACKNOWLEDGED BEFORE ME THIS AD DAY OF S1AX— .20 ;2 O `
gy _,,, /ytwH0 IS PERSONALLY KNOWN TOME 7t . , OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,
/County of
+L J / f as o�o he sra> iv
SIGNATURE OF NOTARY SEAL r Vic:erGAL•erizio
--,m nEx g pres rll:pyN22 minion -e7n2a2
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FOR OFFICE USE ONLY:
Number of Open Inspections!
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
Original permitfee: x % open = $ Renewal fee
Example: [15 divided by23=.65(90)] $175(pennitfee) x.65=$113.75(renewalfee)
Revised 721.Z014
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