HomeMy WebLinkAboutPermit RenewalMay 20 20,10:18a Treasure Coast Roofing 7723438358 p.4
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
S BUILDING AND CODE REGULATIONS DIVISION
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•" e 2300 VIILGINiA AVE
PORT PIERCE, FL 34982 -
(772)462-1553 Fax (772) 462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: Z a O / - Oa W ADDRESS: 6 KC3 L7�Jt,/01�L
I, CP184 7 IffleGlo."Let/ 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,l
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 t?rad r �irrcrl iY/7Mte�'en
OWNE'(Z/ DRO O ACTOR SIGNATURE DATE
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Print ?fame
STATE OF FLORID. /
COUNTY OF J ,
ACKNOWLEDGED. BEFORE ME THIS �/ / g DAY OF ��y • 20 �O
BY &'-e:0 '10"may W H a TR PP L'99 r vvbtl . •OR
HAS PROVIDED %/ AS IDENTTFICATION.
STATE OF LO IDA'-County of Sr// G (/G+C
.�' ,\etary Public Sla:-.
SIGNATURE OF NOTARY ' •.,�`�" 11 Victor G Alleri2-
SEAL :•1y Commission's
Y,p+' Ecpirsstt70512C.: )
FOR OFFICE USE ONLY:
Notary Public State a FlorlUa
Number of Open Inspections: ?`'� X ViC'E'3 tlerizio
Total Inspections: 2` P h1y Cor.+nission GG 274292
.' o� ExPves 11lOSi2022
(Divide open by total to get % of open inspections) °"`
Percentage:
Original permit fee: x %open = $ Renewal fee
Example: [I5 divided by 23=.65(%)] $I75(petmit fee) x .65=$113.75 (renewal fee)
Revisal 7P_I20t4