HomeMy WebLinkAboutPermit RenewalBUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 Fax (772) 462-1578
I I
PERMIT NUMBER: i LD61 ADDRESS: q-�)aS
I, 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. I
Justification
CONTRACTOR SIGNATURE DATE
% I
t6
Print Name
STATE OF FLORI
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS _ap�)AY OF U 20
BY
',I,'HO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED
TE OMORIDA, County of
.TUBE OF NOTARY
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 = S Renewal fee
AS IDENTIFICATION.
y SS A. Doreen Langford
NOTARY PUBLIC
STATE OF FLORIDA
SEAL Comm# GG043591
Expires 12/8/2020
Example: [ 15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7/21/2014
RERma-sw"Id"s-
I W-1 — C)
NOTICE OF COMMENCEMENT
The undersigned heovbv given notice that improvement Will be made to certain real property, and in accordance with Chapter 713,
Florida statutes the following information is provided in the Notice of commencement.
1. DESCRIPTION OF PROPERTY (Legal description and street address) TAX FOLIO NUMBER:3 j3t 01
1
1. OWNER INFORMATION' a. Nam
b. Add c. interest in property—
d, Name and address of (cc simple titleholder (if other than owner)
4. CONTRACTOR'S NAME, ADDRESS AND PHONE NUMBER: bavc-'s
1k1e_:Srt-. -&u - AQ ......... .. .
A;)-+, Fu 3qc-
5. SURETY'S NAME, ADDRESS AND PHONE NUMBER AND BOND AMOUNT:
6. LENDER'S NAME, ADDRESS AND PHONE NUMBER:
7. Persons within the State of Florida designated by Owner upon whom notices or other docUMMIN may be served as provided by
Section 713.13 (1)(a) 7., Florida Statutes:
NAME, ADDRESS AND PHONE NUMBER:
8. In addition to himself or hem -if, Owner designate.-, the following to rcctive a copy of the Licnor'.,i Notice as provided in Section
713.13 (1)(b), Florida Statutes:
NAME, ADDRES*3 AND PHONE NUMBER:
9. Expiration date of notice of commencement (the expiration date is I year from the date of recording unless different date is
specified) _20—.
7L
Signature of Owner or Print Name and Provide Slgnatory',s Tltle/Offt,ce
Owner's Authorized Ofricer/Direi-tor/Partner/Nlnoupr
State of Florida
County of
Th oing instrume t w cknowledged before me this do of 20
ping
By as
(N o person) (Typc of authority ... c.g. Owner, officer. trustee. attorney in fact)
For EA—A-CEL.) -1
T or produced the following type of ID:
(Namcofparty,Rnb%1RfNho1 i!i , yrument was executed) Personally Known2)L.__
ONRY�4& ng or
NOTARY PUBLIC
—STATE OF FLORIDA
(Prin of of
"WW/8/2020
(Signature of Notary Public)
Under penalties of perjury, I declare that I have read the foregoing and that the facts in it are true to the best of my knowledge and
belief tsection 92.525, Florida Statutes).
Signature(s) of Owner(s) or Owner(s)' Authorized Officer/[XrectGr/Partner/,Manager who signed above:
By:
&' tWW_'0V(Rm--d'V)